margaret fahy
Guru
Hi Guys,
What do you think about my codes listed below?
My codes are: 36224-LT; 36227-LT; 36222-RT; 36227-RT; and 61626; 75894; 75898.
Margie
nasopharyngeal angiofibroma. Here for diagnostic angiogram and
preoperative embolization.
PROCEDURE:
1. Ultrasound-guided access of the right common femoral artery.
2. Selective catheterization of the left internal carotid artery
and angiogram.
3. Selective catheterization of the left external carotid artery
and angiogram.
4. Selective catheterization of the left ascending pharyngeal
artery and angiogram.
5. Embolization of the left ascending pharyngeal artery using
PVA.
6. Selective catheterization of the left internal maxillary
artery and angiogram.
7. Embolization of the left internal maxillary artery using PVA
and metallic coils.
4. Selective catheterization of the right common carotid artery
and angiogram.
9. Selective catheterization of the left external carotid artery
and angiogram.
10. Selective catheterization of right internal maxillary artery
and angiogram.
11. Embolization of right internal maxillary artery using PVA.
12. Hemostasis with manual compression.
PROCEDURE IN DETAILS: The skin of the right groin was prepped and
draped in sterile fashion. Under ultrasound guidance, a 21-gauge
needle was inserted into the right common femoral artery. Once
arterial blood return was obtained a .018" Nitrex wire was
placed in the artery. The needle was removed and a 4F
sheath/dilator set was placed over the wire into the artery, then
the wire was exchanged for 0.035" Newton wire. Over the wire a
5Fr Berenstein was advanced into the aortic arch. Selective
catheterization of the left internal carotid artery was
performed. Contrast was injected and DSA angiogram was obtained
in AP and lateral views. Selective catheterization of the left
external carotid artery was performed. Contrast was injected and
DSA angiogram was obtained in AP, lateral and oblique views.
FINDINGS:
1. LEFT INTERNAL CAROTID ARTERY: There is a large area of
contrast enhancement seen in the nasopharyngeal area compatible
with juvenile nasopharyngeal angiofibroma. There are numerous
tiny feeding arteries coming from the petrous and cavernous
segments of left internal carotid artery. Intracranial portions
of left internal carotid arteries are unremarkable.
2. LEFT EXTERNAL CAROTID ARTERY: Again noted is a large area of
contrast enhancement in the nasopharyngeal area compatible with
juvenile nasopharyngeal angiofibroma. The most prominent feeders
of the lesion are coming from left ascending pharyngeal and
internal maxillary arteries.
LEFT EXTERNAL CAROTID ARTERY EMBOLIZATION:
LEFT ASCENDING PHARYNGEAL ARTERY:
Selective catheterization of the left ascending pharyngeal artery
was performed using 2.5F Renegade microcatheter. Contrast was
injected and angiogram was obtained in frontal and lateral views.
This demonstrated significant contrast enhancement of
nasopharyngeal lesion. Mild arterial spasm was noted. This was
treated with nitroglycerin 30 mcg intra-arterially. Embolization
of the left ascending pharyngeal artery was performed using
250-350 ? PVA particles. PVA was injected under fluoroscopic
monitoring until significant stasis of the artery was noted.
LEFT DISTAL IMAX ARTERY:
Selective catheterization of the left internal maxillary artery
was performed using the Renegade microcatheter. Contrast was
injected and angiogram was obtained in frontal and lateral views.
This demonstrated significant contrast enhancement of
nasopharyngeal lesion. Microcatheter was advanced distally.
Embolization of the left internal maxillary artery was performed
using 250-350 ? PVA particles. PVA was injected under
fluoroscopic monitoring until significant stasis of the artery
was noted. Additional embolization of the left internal maxillary
artery was performed using metallic coils. 3 tornado metallic
coils was deployed (2 coils 2 mm x 3 mm x 2 cm and one coil 2 mm
x 3 mm x 4 cm). Post embolization angiogram of the left distal
IMAX artery demonstrated non visualization of the anterior
portion of the lesion treated.
LEFT LEFT EXTERNAL CAROTID ARTERY POST EMBOLIZATION:
Biplane subtraction angiography demonstrated obliteration of the
blush to the anterior portion of the tumor but significant blush
to the tumor being fed directly off the more proximal IMAX. No
significant arterial feeders were noted to the tumor which could
be catheterized.
Selective catheterization was then performed of the right common
carotid artery was performed. Contrast was injected and angiogram
was obtained in frontal and lateral views. Then selective
catheterization of right external carotid artery was obtained.
Contrast was injected and angiogram was obtained in frontal and
lateral views.
Findings:
RIGHT COMMON CAROTID ARTERY: There is some contrast enhancement
of nasopharyngeal lesion. The feeding arteries are coming in an
and and in the and and the primarily from the right external
carotid artery. Intracranial portion of right internal carotid
arteries are unremarkable.
RIGHT EXTERNAL CAROTID ARTERY: There is some contrast enhancement
of nasopharyngeal lesion. Main blood supply of nasopharyngeal
artery is coming from right internal maxillary artery.
RIGHT DISTAL IMAX EMBOLIZATION:
Selective catheterization of the right internal maxillary artery
was performed using 2.5'Renegade microcatheter. Contrast was
injected and angiogram was obtained in frontal and lateral views.
This demonstrated significant contrast enhancement of
nasopharyngeal lesion primarily the anterior aspect. Embolization
of the right internal maxillary artery was performed using
250-350 ? PVA particles. PVA was injected under fluoroscopic
monitoring and significant stasis of the artery was noted. Post
embolization angiogram demonstrated almost complete obliteration
of tumor blush.
Then the catheter and the sheath were removed and manual
compression was applied until hemostasis was achieved.
A sterile occlusive dressing was placed over the site. No
complications were experienced and the patient left the IR suite
in stable condition. Dr. was present for the entire
procedure.
What do you think about my codes listed below?
My codes are: 36224-LT; 36227-LT; 36222-RT; 36227-RT; and 61626; 75894; 75898.
Margie
nasopharyngeal angiofibroma. Here for diagnostic angiogram and
preoperative embolization.
PROCEDURE:
1. Ultrasound-guided access of the right common femoral artery.
2. Selective catheterization of the left internal carotid artery
and angiogram.
3. Selective catheterization of the left external carotid artery
and angiogram.
4. Selective catheterization of the left ascending pharyngeal
artery and angiogram.
5. Embolization of the left ascending pharyngeal artery using
PVA.
6. Selective catheterization of the left internal maxillary
artery and angiogram.
7. Embolization of the left internal maxillary artery using PVA
and metallic coils.
4. Selective catheterization of the right common carotid artery
and angiogram.
9. Selective catheterization of the left external carotid artery
and angiogram.
10. Selective catheterization of right internal maxillary artery
and angiogram.
11. Embolization of right internal maxillary artery using PVA.
12. Hemostasis with manual compression.
PROCEDURE IN DETAILS: The skin of the right groin was prepped and
draped in sterile fashion. Under ultrasound guidance, a 21-gauge
needle was inserted into the right common femoral artery. Once
arterial blood return was obtained a .018" Nitrex wire was
placed in the artery. The needle was removed and a 4F
sheath/dilator set was placed over the wire into the artery, then
the wire was exchanged for 0.035" Newton wire. Over the wire a
5Fr Berenstein was advanced into the aortic arch. Selective
catheterization of the left internal carotid artery was
performed. Contrast was injected and DSA angiogram was obtained
in AP and lateral views. Selective catheterization of the left
external carotid artery was performed. Contrast was injected and
DSA angiogram was obtained in AP, lateral and oblique views.
FINDINGS:
1. LEFT INTERNAL CAROTID ARTERY: There is a large area of
contrast enhancement seen in the nasopharyngeal area compatible
with juvenile nasopharyngeal angiofibroma. There are numerous
tiny feeding arteries coming from the petrous and cavernous
segments of left internal carotid artery. Intracranial portions
of left internal carotid arteries are unremarkable.
2. LEFT EXTERNAL CAROTID ARTERY: Again noted is a large area of
contrast enhancement in the nasopharyngeal area compatible with
juvenile nasopharyngeal angiofibroma. The most prominent feeders
of the lesion are coming from left ascending pharyngeal and
internal maxillary arteries.
LEFT EXTERNAL CAROTID ARTERY EMBOLIZATION:
LEFT ASCENDING PHARYNGEAL ARTERY:
Selective catheterization of the left ascending pharyngeal artery
was performed using 2.5F Renegade microcatheter. Contrast was
injected and angiogram was obtained in frontal and lateral views.
This demonstrated significant contrast enhancement of
nasopharyngeal lesion. Mild arterial spasm was noted. This was
treated with nitroglycerin 30 mcg intra-arterially. Embolization
of the left ascending pharyngeal artery was performed using
250-350 ? PVA particles. PVA was injected under fluoroscopic
monitoring until significant stasis of the artery was noted.
LEFT DISTAL IMAX ARTERY:
Selective catheterization of the left internal maxillary artery
was performed using the Renegade microcatheter. Contrast was
injected and angiogram was obtained in frontal and lateral views.
This demonstrated significant contrast enhancement of
nasopharyngeal lesion. Microcatheter was advanced distally.
Embolization of the left internal maxillary artery was performed
using 250-350 ? PVA particles. PVA was injected under
fluoroscopic monitoring until significant stasis of the artery
was noted. Additional embolization of the left internal maxillary
artery was performed using metallic coils. 3 tornado metallic
coils was deployed (2 coils 2 mm x 3 mm x 2 cm and one coil 2 mm
x 3 mm x 4 cm). Post embolization angiogram of the left distal
IMAX artery demonstrated non visualization of the anterior
portion of the lesion treated.
LEFT LEFT EXTERNAL CAROTID ARTERY POST EMBOLIZATION:
Biplane subtraction angiography demonstrated obliteration of the
blush to the anterior portion of the tumor but significant blush
to the tumor being fed directly off the more proximal IMAX. No
significant arterial feeders were noted to the tumor which could
be catheterized.
Selective catheterization was then performed of the right common
carotid artery was performed. Contrast was injected and angiogram
was obtained in frontal and lateral views. Then selective
catheterization of right external carotid artery was obtained.
Contrast was injected and angiogram was obtained in frontal and
lateral views.
Findings:
RIGHT COMMON CAROTID ARTERY: There is some contrast enhancement
of nasopharyngeal lesion. The feeding arteries are coming in an
and and in the and and the primarily from the right external
carotid artery. Intracranial portion of right internal carotid
arteries are unremarkable.
RIGHT EXTERNAL CAROTID ARTERY: There is some contrast enhancement
of nasopharyngeal lesion. Main blood supply of nasopharyngeal
artery is coming from right internal maxillary artery.
RIGHT DISTAL IMAX EMBOLIZATION:
Selective catheterization of the right internal maxillary artery
was performed using 2.5'Renegade microcatheter. Contrast was
injected and angiogram was obtained in frontal and lateral views.
This demonstrated significant contrast enhancement of
nasopharyngeal lesion primarily the anterior aspect. Embolization
of the right internal maxillary artery was performed using
250-350 ? PVA particles. PVA was injected under fluoroscopic
monitoring and significant stasis of the artery was noted. Post
embolization angiogram demonstrated almost complete obliteration
of tumor blush.
Then the catheter and the sheath were removed and manual
compression was applied until hemostasis was achieved.
A sterile occlusive dressing was placed over the site. No
complications were experienced and the patient left the IR suite
in stable condition. Dr. was present for the entire
procedure.