margaret fahy
Guru
Hey Guys,
Would love some input on this one. Difficult for me.
The diagnostic angiographies, of course, and then the Embolizations.
Angiographies - 36224, 36227 X 3?
Embo - 61626, 75894, 75898............Would this be a case of two surgical fields? 61626 X2? Or is it all Maxillary artery...external and internal...
75898 - Because this is extracranial, do we get to bill just one?
RICA with RECA - is the RECA included in 36224 or is it okay to bill for it?
These are questions I have...
Thanks so much.
Margie
Indications:
Diagnosis:Nasal mass [784.2 (ICD-9-CM)]
Benign tumor of maxillary sinus [212.0 (ICD-9-CM)]
Reason:vascular nasal mass
Patient with right maxillary sinus tumor - need preop angiogram and embolization/Onyx
Interpretation: DIAGNOSTIC CEREBRAL ANGIOGRAM
PROCEDURE: The skin of the groin was prepped and draped in
sterile fashion and local anesthesia using 1 percent buffered
lidocaine was infused over the right common femoral artery.
Using Seldinger technique a 21 needle was inserted into the right
common femoral artery. Once arterial blood return was obtained a
.018" Nitrix wire was placed in the artery. The needle was
removed and a 5F sheath/dilator set was placed over the wire into
the artery and utilized to excise for a .035" Newton. Over the
wire a 5 French Berenstein catheter was advanced until the
catheter was in the right internal carotid artery. Biplane
DSA was performed. The catheter was then placed into the right
external carotid artery and left external carotid artery. Biplane
DSA was performed in each parent artery.
The catheter was then 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. Cahill was
present for the entire procedure.
FINDINGS:
RICA:Biplane subtraction angiography demonstrated the right
opthalmic artery was noted to be present and supplying the right
eye. there was no tumor blush noted to the right maxillary sinus
lesion.
RECA: Biplane subtraction angiography both form the proximal and
distal right external carotid artery demonstrated a vague blush
off the distal right internal maxillary artery without evidence
of an early draining vein.
RIGHT DISTAL IMAX: A 2.4F Renegade catheter was placed in the
distal IMAX artery with a 0.016 Fathom wire and selective and
superselective angiography performed of the distal IMAX and
sphenopalatine artery. Angiography demonstrated an abnormal right
nasal blush without active extravasation at this time.
EMBOLIZATION DISTAL IMAX:
150-250 micron PVA particles were injected into the distal IMAX
branches with a mixture of contrast and saline under subtraction
roadmapping and antegrade flow and stasis was noted in the blush.
A post contrast angiogram demonstrated no filling of the tumor
blush post PVA embolization.
Then coil embolization of the distal IMAX was performed with two
3/2mm Tornado coils and contrast injection then of the distal
IMAX demonstrated active extravasation of contrast via the right
nasal cavity. At that time the Foley balloon in the right nasal
cavity was totally deflated when active extravasation was noted.
Continued coiling was then performed of the main IMAX artery
until complete deflation of the Foley balloon yielded no
bleeding. A total of ten 3/2mm Tornado coils and two 4/2mm
Tornado coils were placed to just distal to the right middle
meningeal artery.
POST EMBOLIZATION ANGIOGRAPHY:
IMAX: Post embolization proximal internal maxillary artery
angiography demonstrated complete absence of the right nasal
blush and no active extravasation. The remaining of the branch
vessels are normal.
RIGHT FACIAL ARTERY: Selective biplane angiography of the right
facial artery demonstrated a blush in the region of the right
maxillary sinus consistent with the sight of the vascular mass.
EMBOLIZATION DISTAL FACIAL ARTERY:
A 2.4F Renegade catheter was placed in the distal right facial
artery with a 0.016 Fathom wire and superselective angiography
performed demonstrated an abnormal right maxillary sinus blush
which was successfully embolized with 150-255 micron PVA
particles until the blush disappears. A post embolization facial
artery run demonstrated no further blush in the sinus.
POST EMBOLIZATION RECA: Angiography demonstrates no evidence of a
blush in the right nasal region or right sinus.
LECA: Biplane subtraction angiography of the left external
carotid artery demonstrated no lesion blush from the
contralateral side.
Permanent US and fluoroscopic images were obtained and stored in
the PACS system.
IMPRESSION
margaret fahy
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Would love some input on this one. Difficult for me.
The diagnostic angiographies, of course, and then the Embolizations.
Angiographies - 36224, 36227 X 3?
Embo - 61626, 75894, 75898............Would this be a case of two surgical fields? 61626 X2? Or is it all Maxillary artery...external and internal...
75898 - Because this is extracranial, do we get to bill just one?
RICA with RECA - is the RECA included in 36224 or is it okay to bill for it?
These are questions I have...
Thanks so much.
Margie
Indications:
Diagnosis:Nasal mass [784.2 (ICD-9-CM)]
Benign tumor of maxillary sinus [212.0 (ICD-9-CM)]
Reason:vascular nasal mass
Patient with right maxillary sinus tumor - need preop angiogram and embolization/Onyx
Interpretation: DIAGNOSTIC CEREBRAL ANGIOGRAM
PROCEDURE: The skin of the groin was prepped and draped in
sterile fashion and local anesthesia using 1 percent buffered
lidocaine was infused over the right common femoral artery.
Using Seldinger technique a 21 needle was inserted into the right
common femoral artery. Once arterial blood return was obtained a
.018" Nitrix wire was placed in the artery. The needle was
removed and a 5F sheath/dilator set was placed over the wire into
the artery and utilized to excise for a .035" Newton. Over the
wire a 5 French Berenstein catheter was advanced until the
catheter was in the right internal carotid artery. Biplane
DSA was performed. The catheter was then placed into the right
external carotid artery and left external carotid artery. Biplane
DSA was performed in each parent artery.
The catheter was then 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. Cahill was
present for the entire procedure.
FINDINGS:
RICA:Biplane subtraction angiography demonstrated the right
opthalmic artery was noted to be present and supplying the right
eye. there was no tumor blush noted to the right maxillary sinus
lesion.
RECA: Biplane subtraction angiography both form the proximal and
distal right external carotid artery demonstrated a vague blush
off the distal right internal maxillary artery without evidence
of an early draining vein.
RIGHT DISTAL IMAX: A 2.4F Renegade catheter was placed in the
distal IMAX artery with a 0.016 Fathom wire and selective and
superselective angiography performed of the distal IMAX and
sphenopalatine artery. Angiography demonstrated an abnormal right
nasal blush without active extravasation at this time.
EMBOLIZATION DISTAL IMAX:
150-250 micron PVA particles were injected into the distal IMAX
branches with a mixture of contrast and saline under subtraction
roadmapping and antegrade flow and stasis was noted in the blush.
A post contrast angiogram demonstrated no filling of the tumor
blush post PVA embolization.
Then coil embolization of the distal IMAX was performed with two
3/2mm Tornado coils and contrast injection then of the distal
IMAX demonstrated active extravasation of contrast via the right
nasal cavity. At that time the Foley balloon in the right nasal
cavity was totally deflated when active extravasation was noted.
Continued coiling was then performed of the main IMAX artery
until complete deflation of the Foley balloon yielded no
bleeding. A total of ten 3/2mm Tornado coils and two 4/2mm
Tornado coils were placed to just distal to the right middle
meningeal artery.
POST EMBOLIZATION ANGIOGRAPHY:
IMAX: Post embolization proximal internal maxillary artery
angiography demonstrated complete absence of the right nasal
blush and no active extravasation. The remaining of the branch
vessels are normal.
RIGHT FACIAL ARTERY: Selective biplane angiography of the right
facial artery demonstrated a blush in the region of the right
maxillary sinus consistent with the sight of the vascular mass.
EMBOLIZATION DISTAL FACIAL ARTERY:
A 2.4F Renegade catheter was placed in the distal right facial
artery with a 0.016 Fathom wire and superselective angiography
performed demonstrated an abnormal right maxillary sinus blush
which was successfully embolized with 150-255 micron PVA
particles until the blush disappears. A post embolization facial
artery run demonstrated no further blush in the sinus.
POST EMBOLIZATION RECA: Angiography demonstrates no evidence of a
blush in the right nasal region or right sinus.
LECA: Biplane subtraction angiography of the left external
carotid artery demonstrated no lesion blush from the
contralateral side.
Permanent US and fluoroscopic images were obtained and stored in
the PACS system.
IMPRESSION
margaret fahy
View Public Profile
Send a private message to margaret fahy
Find all posts by margaret fahy
Add margaret fahy to Your Contacts