# embolization - Two arteries in one vascular



## Shirleybala (Apr 16, 2009)

Hello:
Two arteries in one vascular family is embolized
How many embolization we have to code 1 or 2.

Study: Superior mesenteric arteriogram and superselective embolization of
branches of the right colic and middle colic arteries.
Clinical indication: Recurrent severe lower-gastrointestinal bleeding
from the hepatic flexure.
Procedure: After obtaining informed consent, the patient was placed in
the supine position and the right groin prepped and draped in sterile
fashion. The skin was anesthetized with 1% lidocaine. A micropuncture
needle was used to access the right common femoral artery. Using
Seldinger technique a 5 French vascular sheath was placed. Via this
sheath a 5 French cobra catheter was used to selectively catheterize the
superior mesenteric artery.
Superior mesenteric arteriography revealed hypervascularity involving the
hepatic flexure. Via the cobra catheter, a Tracker micro-catheter was
advanced into the branch of the right colic artery supplying the hepatic
flexure. Hypervascularity without active extravasation was identified.
CO2 was injected in an attempt to better elucidate extravasation without
success. Given the firm confirmation of bleeding from the hepatic flexure
on endoscopy, it seemed prudent to perform coil embolization with three 2
mm in diameter x 2 cm in length micro-coils. This resulted in sluggish
flow through this artery.
Following the right colic artery embolization, the middle colic artery
was selectively catheterized and the branch supplying the hepatic flexure
also catheterized. Again, 2 mm in diameter micro-coils were deployed x
two into this branch. This also resulted in sluggish flow to the hepatic
flexure branch.
Following the procedure, the catheter and sheaths were removed from the
right groin and pressure applied for 10 minutes. There is no
postprocedural hematoma, no change in distal vascular examination. The
patient tolerated the procedure well and was transported to her room in
stable condition.
Findings were discussed with *******, consulting gastrointestinal
surgeon 3/27/09 at approximately 1:30 pm.
IMPRESSION:  Status-post superselective embolization of branches of the
right colic and middle colic artery as described above.


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## dhuston (Apr 17, 2009)

It appears to be one operative site.  Often times more than one vessel needs to be embolized to stop GI bleed but you only code the embo once.  It had been an open procedure, how many openings would have been needed to do this procedure?  That's how to determine whether to code multiple embolizations.

Diane Huston, CPC,RCC


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## MLS2 (Apr 20, 2009)

75726
75774x2
36246
36248
75894
37204


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