# Visceral embolization



## elamathi (Jun 10, 2009)

Please clarify the codes for the procedure..
Do we need to code embolization X2.  
76937
36216
75710
75756
36246
75726
75774
36245-59
75726-59
36245-59
75705
37204
75894
75898


155.0


PROCEDURE:
1. Left subclavian arteriogram
2. Left internal mammary arteriogram
3. Flush abdomina aortogram
4. Celiac arteri gr m
5. Left inferior phrenic arteriogram
6. Left inferior phrenic artery embolization
7. Right lumbar arteriogram
8. Right lumbar artery embolization
9. Left gastric a rter iogram
male with multifocal hepatocellular carcinoma.
MEDICATIONS C nscious sedation was provided for patient's comfort. Vitals were monitored prior, during and afte th procedure and were stable. Total time of monitored sedation was 90 minutes. 
ACCESS SITE: Right common femoral artery
PROCEDURE:
The risks, bene Its, and alternatives to the procedure and sedation were explained to the patient and patient's family, an written informed consent obtained.
The patient was pl ced in supine position on the angiography table and the right groin was prepped
 and draped in steril fashion.   
The skin and subcutaneous tissue overlying the right common femoral d with 2% lidocaine for local anesthetic. The right common femoral artery was nicropuncture needle. A 0.018 a wire was advanced through the needle into the  artery was documented and store to PACS. The needle was exchanged for 5 french transitional catheter. The inner dilator and the 0.018 wire were removed and a 0.035 dvanced into the artery. The transitional catheter was exchanged for 5 French vascular sheath whiich was attached to a pressurized, heparinized bag of normal saline.
5 french catheter was advanced over the wire and used to cannulate the left subclavian ng arteriogram was performed. A high flow renegade microcatheter was coaxially 3 GT Glidewire which was used and the left internal mammary artery. Corresponding rformed. The microcatheter was removed.
the catheter was exchanged for a pigtail catheter. Flush aortogram was performed. The exchanged for a 5 French Mickelson catheter. This catheter was used to axis. Digital subtraction angiography was performed.
en used to select the left inferior phrenic artery. Corresponding arteriogram was low renegade microcatheter was coaxially loaded over a 0.018 GT Glidewire and e artery. This was then embolized with 100 - 300 micron Embosphere particles.
en used to select a collateral right lumbar artery. Corresponding arteriogram was ow renegade microcatheter was coaxially loaded over a 0.018 GT Glidewire and e artery. This was then embolized with 100 - 300 micron Embosphere particles.
ati eter was then used to select the left gastric artery and corresponding arteriogram
re oved and hemo$tasis achieved utilizing manual compression. The patient ce ure well and left the angiography suite in stable condition without any immediate r plications.


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## dpeoples (Jun 10, 2009)

elamathi said:


> Please clarify the codes for the procedure..
> Do we need to code embolization X2.
> 76937
> 36216
> ...



Here is what I have:

37204 (only once per operative field) 
75894
36216 for the LIMA
36245 Inferior Phrenic _corrected_ (yes this artery generally arises from the Aorta, any variant anatomy would change the order).
36246-59 Lt Gastric
36245-59 Rt Lumbar

I did not see any interpretations for the selected vessels so I would not code any S & I codes. Perhaps you did not copy that information?
I also did not see any F/U angiography interpretations.

I am also wondering why the left subclavian/internal mammary were selected ( and perhaps imaged)? Where is the medical necessity for that?

I hope this helps.


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## elamathi (Jun 11, 2009)

Hi Dpeople,

Sorry, I have missed out while copying the doc.. But I just want to clarify whether Inferior phrenic artery arises from the aorta or celiac axis.  According to Zhealth, the catheterization for IFA was coded as 36245/75774 and the anatomy also showed that it directly arises from the aorta.  Your comments on this...


Elamathi


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## MLS2 (Jun 11, 2009)

I have the phrenic as coming off of the celiac artery...I guess the anatomy could vary though.


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## dpeoples (Jun 11, 2009)

elamathi said:


> Hi Dpeople,
> 
> Sorry, I have missed out while copying the doc.. But I just want to clarify whether Inferior phrenic artery arises from the aorta or celiac axis.  According to Zhealth, the catheterization for IFA was coded as 36245/75774 and the anatomy also showed that it directly arises from the aorta.  Your comments on this...
> 
> ...



I have edited my previous post. 
dp


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