# Status post EVAR eight years ago with Type



## Shirleybala (Jul 18, 2008)

Status post EVAR eight years ago with Type
      II leak and aneurysm enlargement on CT.
Procedure:
      right common femoral artery was punctured with a 19 gauge needle
      and a 5 French sheath introduced over a Newton J. wirre.  Through
      this and Omniflush catheter was positioned  first above the top of
      the graft and then  in the graft to assess for a leak.  A third
      injection was performed in the right limb.The catheter was then
      exchanged for a Sos catheter and selective injections performed on
      the left limb. The catheter was then manipulated into the superior
      mesenteric artery and an injection performed.
  Findings.  Abdominal aortogram.

      There is no evidence of a leak at either end of the device, nor is
      then a defect in the graft.

      An injection in the right limb iin 2 obliques demonstrates no Type
      IIb  leak.  The hypogastric artery is patent but does not opacify
      the leak seen on CT.

      Injections in the left limb of the graft again demonstrated no Ib
      the leak.  There is a large deep circumflex iliac which
      contributes a vessel which probably supplies the leak.  There is a
      surgical graft from the external iliac artery to the hypogastric
      artery and the iliolumbar artery appears to supply a vessel to the
      leak.

      Superior mesenteric arteriogram.
CPT codes:
36245
36245-59
75726-26
75736-26
can i give 75736 for left limb (graft)injection and angiography of pelvic vessels  (Since it can be used only with selective catheterization of internal iliacs)

Thanks 
Shirleybala.


----------



## MLS2 (Jul 19, 2008)

it's hard to tell if the internal iliac was actually "selected" to do the injection.  Was the left limb in the internal iliac artery?  If it was, then I would say yes to the 75736.  If you're not sure, I would check with the physician and have him addend the report to say so.  You might just end up with a 75710.
hope that helps!


----------

