iamlou
Networker
Hi,
Can someone PLEASE help with this? I don't know if it's because it's Monday, or because I'm confused with the new CPT embolization codes. Probably a little of both. I'm attaching the op report. The guidelines for the embo codes say that cath placement and diagnostic studies can be separately reported, but how do you know when cath placement and guidance become roadmapping and intra-procedural guidance? This confuses me. Any and all help is greatly appreciated! At this point the only thing I know for sure is 37244.
PROCEDURES PERFORMED:
Mesenteric angiography and embolization, cone beam CTA and fusion
ACCESS SITE:
Right common femoral artery
CATHETER POSITION:
Celiac artery, superior mesenteric artery, right colic artery
Under ultrasound guidance, the right common femoral artery was
accessed. Over a guidewire a 6 French sheath was inserted. Over the
guidewire through the sheath a 5 French Reuter catheter was placed into the
abdominal aorta. Cone beam CTA was performed. The images were fused with prior CTA. I-Pilot guidance systems were utilized to enhance selective
catheterization in this patient with known thoracic and abdominal aortic
pathology. The Reuter catheter was initially positioned in the celiac
artery. Injections were performed. The catheter then was repositioned in
the superior mesenteric artery. There is extensive calcified plaque at the
origin of the SMA. The cone beam CTA fusion images were utilized to
selectively catheterize the SMA. Injections into the SMA with a 5 French
Reuter catheter were incomplete as the catheter was unable to fully engage
the arterial lumen due to the occlusive disease. As such, the catheter was
exchanged over a guidewire for a 5 French C2 glide catheter which is
positioned at the origin of the SMA. Injections were performed. Through
this a coaxial 0.014 inch Rugulia guidewire and 3 French renegade
microcatheter were carefully advanced into the proximal SMA. Injections
were performed. There is active extravasation identified in the terminal
branch of the right colic artery approximating the cecum, at the level of
multiple endoscopically placed clips. Using roadmapping technique and
vessel overlay technique, the microcatheter was carefully advanced over the
0.014 inch Rugulia wire, as well as a 0.018 inch double angle Glidewire.
The microcatheter sequentially advanced across the SMA, into the right
colic artery. Selective injections were performed. The catheter was
subsequently further advanced across the right colic artery into the
terminal branch arcades. The dominant bleeding site was superselectively
cannulated at the level of the mesenteric side cecum. Superselective
injections were performed which demonstrates brisk extravasation of
contrast into the cecum at the level of the previously placed clips. The
catheter was secured in position, and subsequently a 3 mm x 6 cm 0.018 inch
interlock detachable coil was placed and deployed without incident. The
catheter was repositioned in the more central right colic artery and
injections performed documenting occlusion of the targeted branch, and
cessation of angiographic active extravasation. The subjacent arcades were
preserved. The microcatheter was removed. The catheter was removed. The sheath was removed, and access site closed using Starr close.
A sterile dressing was applied..
FINDINGS:
There is extensive calcific atherosclerotic disease of the proximal
abdominal aorta. There is a patent infrarenal abdominal aortic aneurysm
tube graft. There is a right renal artery stent which is not selectively
engaged, however nonselective injections of the juxta renal aorta
demonstrates flow through the stent. Celiac artery is patent. The
splenic, common hepatic, left gastric, gastroduodenal, intrahepatic
arterial branches are patent.
SMA demonstrates high-grade bulky exophytic calcified plaque at its origin,
with resultant stenosis in excess of 90-95 percent. This selectively
canalized using a coaxial system of a 5 French C2 glide catheter positioned
at the origin of the SMA, and a 3 French renegade catheter within the SMA
and SMA branches. Injection demonstrates brisk acute extravasation from a
terminal branch of the right colic artery, at the level of the previously
endoscopically placed coils. As described in detail above, this was
treated with superselective catheterization and embolization of the
bleeding site. Completion study demonstrates complete cessation of
angiographic acute extravasation. The subjacent arcades and bowel branches
are patent.
COMPLICATIONS: None.
IMPRESSION:
MESENTERIC ANGIOGRAPHY, CONE BEAM CT MESENTERIC ANGIOGRAPHY AND FUSION FOR GUIDANCE AS DESCRIBED ABOVE DEMONSTRATE ACUTE EXTRAVASATION FROM A TERMINAL CECAL BRANCH FROM THE RIGHT COLIC ARTERY. THIS WAS TREATED WITH SUPERSELECTIVE DETACHABLE MICROCOIL EMBOLIZATION WITH SATISFACTORY ANGIOGRAPHIC RESULT.
Can someone PLEASE help with this? I don't know if it's because it's Monday, or because I'm confused with the new CPT embolization codes. Probably a little of both. I'm attaching the op report. The guidelines for the embo codes say that cath placement and diagnostic studies can be separately reported, but how do you know when cath placement and guidance become roadmapping and intra-procedural guidance? This confuses me. Any and all help is greatly appreciated! At this point the only thing I know for sure is 37244.
PROCEDURES PERFORMED:
Mesenteric angiography and embolization, cone beam CTA and fusion
ACCESS SITE:
Right common femoral artery
CATHETER POSITION:
Celiac artery, superior mesenteric artery, right colic artery
Under ultrasound guidance, the right common femoral artery was
accessed. Over a guidewire a 6 French sheath was inserted. Over the
guidewire through the sheath a 5 French Reuter catheter was placed into the
abdominal aorta. Cone beam CTA was performed. The images were fused with prior CTA. I-Pilot guidance systems were utilized to enhance selective
catheterization in this patient with known thoracic and abdominal aortic
pathology. The Reuter catheter was initially positioned in the celiac
artery. Injections were performed. The catheter then was repositioned in
the superior mesenteric artery. There is extensive calcified plaque at the
origin of the SMA. The cone beam CTA fusion images were utilized to
selectively catheterize the SMA. Injections into the SMA with a 5 French
Reuter catheter were incomplete as the catheter was unable to fully engage
the arterial lumen due to the occlusive disease. As such, the catheter was
exchanged over a guidewire for a 5 French C2 glide catheter which is
positioned at the origin of the SMA. Injections were performed. Through
this a coaxial 0.014 inch Rugulia guidewire and 3 French renegade
microcatheter were carefully advanced into the proximal SMA. Injections
were performed. There is active extravasation identified in the terminal
branch of the right colic artery approximating the cecum, at the level of
multiple endoscopically placed clips. Using roadmapping technique and
vessel overlay technique, the microcatheter was carefully advanced over the
0.014 inch Rugulia wire, as well as a 0.018 inch double angle Glidewire.
The microcatheter sequentially advanced across the SMA, into the right
colic artery. Selective injections were performed. The catheter was
subsequently further advanced across the right colic artery into the
terminal branch arcades. The dominant bleeding site was superselectively
cannulated at the level of the mesenteric side cecum. Superselective
injections were performed which demonstrates brisk extravasation of
contrast into the cecum at the level of the previously placed clips. The
catheter was secured in position, and subsequently a 3 mm x 6 cm 0.018 inch
interlock detachable coil was placed and deployed without incident. The
catheter was repositioned in the more central right colic artery and
injections performed documenting occlusion of the targeted branch, and
cessation of angiographic active extravasation. The subjacent arcades were
preserved. The microcatheter was removed. The catheter was removed. The sheath was removed, and access site closed using Starr close.
A sterile dressing was applied..
FINDINGS:
There is extensive calcific atherosclerotic disease of the proximal
abdominal aorta. There is a patent infrarenal abdominal aortic aneurysm
tube graft. There is a right renal artery stent which is not selectively
engaged, however nonselective injections of the juxta renal aorta
demonstrates flow through the stent. Celiac artery is patent. The
splenic, common hepatic, left gastric, gastroduodenal, intrahepatic
arterial branches are patent.
SMA demonstrates high-grade bulky exophytic calcified plaque at its origin,
with resultant stenosis in excess of 90-95 percent. This selectively
canalized using a coaxial system of a 5 French C2 glide catheter positioned
at the origin of the SMA, and a 3 French renegade catheter within the SMA
and SMA branches. Injection demonstrates brisk acute extravasation from a
terminal branch of the right colic artery, at the level of the previously
endoscopically placed coils. As described in detail above, this was
treated with superselective catheterization and embolization of the
bleeding site. Completion study demonstrates complete cessation of
angiographic acute extravasation. The subjacent arcades and bowel branches
are patent.
COMPLICATIONS: None.
IMPRESSION:
MESENTERIC ANGIOGRAPHY, CONE BEAM CT MESENTERIC ANGIOGRAPHY AND FUSION FOR GUIDANCE AS DESCRIBED ABOVE DEMONSTRATE ACUTE EXTRAVASATION FROM A TERMINAL CECAL BRANCH FROM THE RIGHT COLIC ARTERY. THIS WAS TREATED WITH SUPERSELECTIVE DETACHABLE MICROCOIL EMBOLIZATION WITH SATISFACTORY ANGIOGRAPHIC RESULT.