hwilcox07
Networker
Can I bill all of these codes for the following report?? Thanks in advance for any advice.
Catheterizations:
36245-59- SMA
36247 - GDA
36248 - Cystic
36248 - RHA
36248 - LHA
Arteriograms:
75726 - SMA
75726-76 - Celiac
75774 - GDA
75774 - Cystic
75774 - RHA
75774 - LHA
75710 - RLE
37243 - Embolization
(The MAA injections will be reported separately from Nuc Med)
ROENTGENOLOGICAL FINDINGS:
XRAY SPECIAL PROCEDURE W/CONTRAST
HISTORY: MAL NEO LIVER, PRIMARY
PROCEDURES: SMA and celiac artery angiography, right lower extremity
angiography, MinxGrip deployment, right and left hepatic artery shunt
injections, cystic artery angiography and embolization and angiogram to
check results, gastroduodenal artery angiography and embolization and
angiogram to check results, right and left hepatic artery angiogram, and
left gastric artery angiography.
HISTORY: Hepatocellular carcinoma pre SIR-Sphere infusion/treatment.
After extending the procedure, alternatives and risks, informed consent
was given.
The patient was placed in the supine position and the right groin was
prepped. Using ultrasound guidance and a maximum sterile barrier, a single
puncture was made. Serial dilatation was performed and a 6 French sheath
inserted. Through this a Simmons 2 carrier catheter and a SOS catheter
were used to perform the above angiogram.
FINDINGS:
RIGHT LOWER EXTREMITY ANGIOGRAPHY:
The common iliac and external iliac arteries are widely patent.
AORTOGRAM:
Injection demonstrates normal renal arteries. There is a left-sided
abdominal aortic aneurysm which measures 9.0 x 6.6 mm and is unchanged
from previous CT exams dating back to 7/12/2012.
SMA INJECTION:
There is normal branching pattern to the SMA without evidence of replaced
hepatic branch.
Celiac artery injection: There is a normal splenic, left gastric, right
and left hepatic arteries and gastroduodenal branches. The hepatic
arterial tree is slightly small but tumor nodules are seen on delayed
imaging over the liver.
LEFT HEPATIC ARTERIAL INJECTION:
Study demonstrates multiple tumor vessels with a blush seen over the
central left lobe of the liver. Slight irregularity is seen but no branch
is noted to the stomach.
FIRST SHUNT SITE INJECTION:
The first injection of the technetium 99m MAA was performed at this site.
GASTRODUODENAL ARTERY ANGIOGRAPHY AND EMBOLIZATION AND ANGIOGRAM TO CHECK
RESULTS:
Angiogram demonstrates normal anatomical path to the gastroduodenal
artery. Normal flow is seen. No endoluminal thrombus. Gastroduodenal
artery was entered. A series of interlock coils were deployed up to the
margin of the artery without evidence of problem.
ANGIOGRAM TO CHECK RESULTS:
Repeat carrier catheter injection demonstrates excellent positioning of
the endovascular coils without significant flow.
CYSTIC ARTERY ANGIOGRAPHY EMBOLIZATION AND ANGIOGRAM TO CHECK RESULTS:
The cystic artery was cannulated and injection demonstrates normal
branches over the margin of the gallbladder. Minimal blush by the
gallbladder fossa. Subsequently, a single 2 x 6 mm vortex interlock coil
was deployed. Repeat injection demonstrated minimal antegrade flow but
this should be adequate.
RIGHT HEPATIC ARTERY ANGIOGRAPHY:
Study demonstrates at least five separate tumor nodules in the right lobe
of the liver. Normal size hepatic branches are seen otherwise. No colonic
collateral.
SECOND SHUNT SITE INJECTION:
The second half of the technetium 99m MAA was injected at this site
without problem.
LEFT GASTRIC ARTERY ANGIOGRAPHY:
Injection demonstrates normal left gastric branches. There is a tiny
collateral to the right half of the liver but no connection to the hepatic
arterial tree as best can be discerned.
MinxGrip was deployed. Orders written. No evidence of immediate post
procedure complication. Patient should be ready for SIR-Sphere infusion.
IMPRESSION:
Successful embolization of gastroduodenal artery and the cystic artery.
Successful right and left hepatic arterial branch shunt injections.
Multiple enhancing intrahepatic tumors. Small stable aneurysm left side of
the aorta.
No evidence of immediate post procedure complication.
FLUOROSCOPIC TIME: 14.4 minutes.
TIMEOUT: Observed.
Catheterizations:
36245-59- SMA
36247 - GDA
36248 - Cystic
36248 - RHA
36248 - LHA
Arteriograms:
75726 - SMA
75726-76 - Celiac
75774 - GDA
75774 - Cystic
75774 - RHA
75774 - LHA
75710 - RLE
37243 - Embolization
(The MAA injections will be reported separately from Nuc Med)
ROENTGENOLOGICAL FINDINGS:
XRAY SPECIAL PROCEDURE W/CONTRAST
HISTORY: MAL NEO LIVER, PRIMARY
PROCEDURES: SMA and celiac artery angiography, right lower extremity
angiography, MinxGrip deployment, right and left hepatic artery shunt
injections, cystic artery angiography and embolization and angiogram to
check results, gastroduodenal artery angiography and embolization and
angiogram to check results, right and left hepatic artery angiogram, and
left gastric artery angiography.
HISTORY: Hepatocellular carcinoma pre SIR-Sphere infusion/treatment.
After extending the procedure, alternatives and risks, informed consent
was given.
The patient was placed in the supine position and the right groin was
prepped. Using ultrasound guidance and a maximum sterile barrier, a single
puncture was made. Serial dilatation was performed and a 6 French sheath
inserted. Through this a Simmons 2 carrier catheter and a SOS catheter
were used to perform the above angiogram.
FINDINGS:
RIGHT LOWER EXTREMITY ANGIOGRAPHY:
The common iliac and external iliac arteries are widely patent.
AORTOGRAM:
Injection demonstrates normal renal arteries. There is a left-sided
abdominal aortic aneurysm which measures 9.0 x 6.6 mm and is unchanged
from previous CT exams dating back to 7/12/2012.
SMA INJECTION:
There is normal branching pattern to the SMA without evidence of replaced
hepatic branch.
Celiac artery injection: There is a normal splenic, left gastric, right
and left hepatic arteries and gastroduodenal branches. The hepatic
arterial tree is slightly small but tumor nodules are seen on delayed
imaging over the liver.
LEFT HEPATIC ARTERIAL INJECTION:
Study demonstrates multiple tumor vessels with a blush seen over the
central left lobe of the liver. Slight irregularity is seen but no branch
is noted to the stomach.
FIRST SHUNT SITE INJECTION:
The first injection of the technetium 99m MAA was performed at this site.
GASTRODUODENAL ARTERY ANGIOGRAPHY AND EMBOLIZATION AND ANGIOGRAM TO CHECK
RESULTS:
Angiogram demonstrates normal anatomical path to the gastroduodenal
artery. Normal flow is seen. No endoluminal thrombus. Gastroduodenal
artery was entered. A series of interlock coils were deployed up to the
margin of the artery without evidence of problem.
ANGIOGRAM TO CHECK RESULTS:
Repeat carrier catheter injection demonstrates excellent positioning of
the endovascular coils without significant flow.
CYSTIC ARTERY ANGIOGRAPHY EMBOLIZATION AND ANGIOGRAM TO CHECK RESULTS:
The cystic artery was cannulated and injection demonstrates normal
branches over the margin of the gallbladder. Minimal blush by the
gallbladder fossa. Subsequently, a single 2 x 6 mm vortex interlock coil
was deployed. Repeat injection demonstrated minimal antegrade flow but
this should be adequate.
RIGHT HEPATIC ARTERY ANGIOGRAPHY:
Study demonstrates at least five separate tumor nodules in the right lobe
of the liver. Normal size hepatic branches are seen otherwise. No colonic
collateral.
SECOND SHUNT SITE INJECTION:
The second half of the technetium 99m MAA was injected at this site
without problem.
LEFT GASTRIC ARTERY ANGIOGRAPHY:
Injection demonstrates normal left gastric branches. There is a tiny
collateral to the right half of the liver but no connection to the hepatic
arterial tree as best can be discerned.
MinxGrip was deployed. Orders written. No evidence of immediate post
procedure complication. Patient should be ready for SIR-Sphere infusion.
IMPRESSION:
Successful embolization of gastroduodenal artery and the cystic artery.
Successful right and left hepatic arterial branch shunt injections.
Multiple enhancing intrahepatic tumors. Small stable aneurysm left side of
the aorta.
No evidence of immediate post procedure complication.
FLUOROSCOPIC TIME: 14.4 minutes.
TIMEOUT: Observed.