# Uterine Artery Embolization - Am I seeing this right?



## JGolamco (Feb 4, 2014)

Am I seeing this right? 


36247-50
36247-59
75736
75736-59
75774
37243




REASON FOR EXAM:
SYMPTOMATIC UTERINE FIBROIDS 


EXAMINATION:
UTERINE ARTERY EMBOLIZATION

. . .


PROCEDURE:
The patient was brought into the angio suite. Conscious sedation was provided with 3 mg Versed and 150 mcg fentanyl by a registered nurse under direct physician supervision with continuous cardiopulmonary monitoring throughout the procedure.

Procedure time 1 hour 15 minutes.

Lidocaine 1% was used as local anesthetic. Puncture was made of the right common femoral artery using ultrasound imaging. A 0.018" wire followed easily. A microcatheter was taken over the wire into the artery and the inner dilator and wire were removed. A 0.035" Bentson wire was then passed near the aorta and the catheter removed. A 5-French sidearm sheath was placed. A SOS Omni catheter was formed in the proximal descending aorta and brought into the origin of the left common iliac artery. A wire was then passed into the left superficial femoral artery using fluoroscopic imaging. The catheter was removed and a Roberts Uterine Catheter was formed over the aortic bifurcation and pushed up into the aorta to form a Waltman loop. It was then used to select the left internal iliac artery for left internal iliac artery angiogram. The microcatheter was then used to select the uterine artery for uterine artery angiogram. The horizontal portion of the uterine artery was passes and embolization was performed first with Embospheres 500-700 micron in size and then polyvinyl alcohol 300-500 microns in size. A completion angiogram was performed. The microcatheter was removed and the catheter pushed back into the aorta and then engaged in the right ipsilateral common iliac artery and the right internal iliac artery for right internal iliac artery angiogram.

The microcatheter was then used to select the uterine artery and again the horizontal portion and branches to the cervix were passed and then embolization was performed again with Embospheres 500-700 micron in size and then polyvinyl alcohol 300-500 microns in size.

Completion angiogram was performed. The catheter was then pushed up into the aorta and again the left superficial femoral artery was selected and the catheter brought down into the left common femoral artery and the catheter was withdrawn to unform the loop and remove the catheter. The sheath was then flushed with saline and then pulled and pressure was held. The patient tolerated the procedure well.

Fluoroscopy time is 17 minutes.

Contrast total is 110 mL.


FINDINGS:
Left internal iliac artery angiogram shows a normal arrangement of the left internal iliac artery.

Perhaps there is a high origin of the cervical branches of the left uterine artery.

Left uterine artery angiogram shows filling of the fibroids of the uterus.

Completion angiogram shows slow filling of the uterine artery.

Right internal iliac artery angiogram shows a hypertrophied right uterine artery.

Right uterine artery shows filling of the enlarged uterus.

Postembolization angiogram shows filling of the uterine artery.

Ultrasound of the right common femoral artery shows a normal appearing right common femoral artery with good needle tip positioning.


IMPRESSION:
Successful bilateral uterine artery embolization as described above.


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## Jim Pawloski (Feb 4, 2014)

JoeG23 said:


> Am I seeing this right?
> 
> 
> 36247-50
> ...



No, your looking at a new code, 37243.  It includes all catheterizations and imaging.
HTH,
Jim Pawloski, CIRCC


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## JGolamco (Feb 4, 2014)

Jim,

Thank you! ..."catheter placement(s) and diagnostic studies may be separately reported..." threw me off... thanks again!


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## dpeoples (Feb 5, 2014)

Well, I am afraid I have to partly disagree with Jim. The catheter placement codes (36247) are billable with UFE. Also, "diagnostic images" can also be billed, but there is a very subjective nature to determining whether or not images are diagnostic. My rule is, do they already know what the problem (diagnosis) is? In this case, they do, it is listed under the "reason for exam" ie symptomatic uterine fibroids.
So, diagnostic radiography should not be billed in this case.

I would code this:
37243
36247 (x2) modified for your payor.

HTH


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## JGolamco (Feb 6, 2014)

Great minds don't always think alike... thank you gentlemen!


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