# endoleak embolization - help!!!



## EikaMTGQueen (Nov 15, 2012)

Reason for Study: AAA ENDOLEAK  

Reason For Visit: AAA  

Impression: 
1. Type II endoleak from lumbar collaterals.  

2. Embolization: distal IMA and L3-L4 of lumbar arteries bilaterally. 
Onyx and thrombin were injected into the sac.  

History: Type II endo leak with enlarging aneurysm.  

Anesthesia: 
1. 1% lidocaine.  
2. Versed none mg IV.  
3. Fentanyl 50 mcg IV.  

Other medication: 
1. Ancef 1 gram IV.  

Contrast: Isovue-250: 50 ml  

Approach: Translumbar  

Estimated Blood Loss: Minimal, Fluoro time: 32.2 minutes.  

Procedure:  
Informed consent was obtained. The risk benefits and alternative 
procedures were discussed. Risks included death, bleeding, need for 
emergent surgery, renal failure and contrast reaction.  

The left flank was sterilely prepped and draped. The skin was 
anesthetized with lidocaine. The aneurysmal sac was entered. A 
catheter was placed in the over a wire. Contrast was injected to  
 characterize the endoleak.  

Embolization:  
1. IMA origin was embolized with 3 x 14 mm coil. Left colic artery 
was not visualized.  
2. L3-L4 lumbar x2 were embolized again with coils with Onyx.  

3. Sac thrombosis: Aneurysm sac was thrombosed by injecting 1000 
units of thrombin completion of the embolization  

Upon completion of the procedure the catheter was removed.  

Findings:  

Aorta:  

Sac examination: filling the IMA and L3-L4 lumbars as well as large 
amount of dense base within the sac itself. Branches were embolized 
as noted above. The sac was thrombosed with thrombin.


How would you code this?

Thanks


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## dpeoples (Nov 16, 2012)

EikaMTGQueen said:


> Reason for Study: AAA ENDOLEAK
> 
> Reason For Visit: AAA
> 
> ...



I would code this:
37204/75894
36245 (x3) for IMA and 2 lumbar arteries

HTH


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## Lynda Wetter (Nov 16, 2012)

dpeoples said:


> I would code this:
> 37204/75894
> 36245 (x3) for IMA and 2 lumbar arteries
> 
> HTH



You wouldnt code the embolizations of the lumbar arteries?


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## EikaMTGQueen (Nov 16, 2012)

That would be my question - would you code for the lumbar embolization also? or is that 37204 and not 61624?
thanks


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## dpeoples (Nov 16, 2012)

EikaMTGQueen said:


> That would be my question - would you code for the lumbar embolization also? or is that 37204 and not 61624?
> thanks



The embolization code should be used once per surgical field (lower abdominal aorta), not per vessel treated.


HTH


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