smorgan417
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Can you please help code this TACE procedure? I have not coded one before and what I find for the codes do not agree with the billing company 100%. The report is below:
EXAM: SP ARTERIAL INTERNVE Date of Exam: 12/09/2014
IMPRESSION: Successful DEBDOX-TACE of multifocal hepatocellular carcinoma within the right hepatic arterial distribution utilizing 75 mg doxorubicin infused 100-300 micron LC beads, as described. The patient will follow up in 3 months for a multiphasic hepatic MRI to assess therapeutic results.
HISTORY: Multifocal hepatocellular carcinoma. DEBDOX-TACE #4.
Radiologist performing procedure: John Doe, MD
Procedure/Technique: The patient was placed supine on the angiography table with the right groin prepped and draped in usual sterile fashion. Conscious sedation was provided utilizing incremental doses of Versed and fentanyl to achieve moderate sedation. A time-out procedure was performed to confirm the specific procedure, birthdate and the patient name. Through an anesthetized approach and utilizing fluoroscopic guidance access was obtained of the right common femoral artery using a 19-gauge singlewall puncture needle. A J-wire was advanced into the abdominal aorta. The puncture needle was then exchanged for a 5 French angiographic sheath. A 5 fr C2 glide catheter was then used to gain access to the celiac artery. This was then selectively placed in the splenic artery and a portal venogram was performed. The portal vein was patent with appropriate directional flow. Then using an 035 angled Glidewire and 5 fr C2 glide catheter access was obtained to the common hepatic artery. A selective arteriogram was performed and demonstrated a normal branching pattern. Tumor vascularity was identified. The cystic artery was identified. Again using an 035 angled Glidewire and a C2 glide catheter access was obtained to the right hepatic artery distal to the cystic artery. Selective arteriogram demonstrated tumor vascularity within this distribution. 4 cc of intra-arterial 1% lidocaine was infused. This was then followed by chemoembolic infusion of 100-300 micron doxorubicin LC beads. A total of 75 mg was administered within this arterial distribution. 3 cc of intra-arterial 1% lidocaine was then infused. After the superselective infusion was performed, the C2 glide catheter was removed. Then an arteriogram was performed of the right common femoral arteriotomy site. This demonstrated the vessel to be of normal caliber and without significant arterial vascular disease. Therefore the arteriotomy site was sealed with a Mynx device. The patient tolerated the procedure well and no immediate competitions were observed.
Contrast/Medications:
1. 10 cc 1% lidocaine for local anesthetic.
2. 3 mg Versed.
3. 100 mcg fentanyl.
4. 50 cc of Isovue-370.
5. 7 cc of 1% lidocaine used for intra-arterial infusion.
Complications: None.
Fluoroscopy time: Six minutes.
Conscious sedation: 40 minutes.
EXAM: SP ARTERIAL INTERNVE Date of Exam: 12/09/2014
IMPRESSION: Successful DEBDOX-TACE of multifocal hepatocellular carcinoma within the right hepatic arterial distribution utilizing 75 mg doxorubicin infused 100-300 micron LC beads, as described. The patient will follow up in 3 months for a multiphasic hepatic MRI to assess therapeutic results.
HISTORY: Multifocal hepatocellular carcinoma. DEBDOX-TACE #4.
Radiologist performing procedure: John Doe, MD
Procedure/Technique: The patient was placed supine on the angiography table with the right groin prepped and draped in usual sterile fashion. Conscious sedation was provided utilizing incremental doses of Versed and fentanyl to achieve moderate sedation. A time-out procedure was performed to confirm the specific procedure, birthdate and the patient name. Through an anesthetized approach and utilizing fluoroscopic guidance access was obtained of the right common femoral artery using a 19-gauge singlewall puncture needle. A J-wire was advanced into the abdominal aorta. The puncture needle was then exchanged for a 5 French angiographic sheath. A 5 fr C2 glide catheter was then used to gain access to the celiac artery. This was then selectively placed in the splenic artery and a portal venogram was performed. The portal vein was patent with appropriate directional flow. Then using an 035 angled Glidewire and 5 fr C2 glide catheter access was obtained to the common hepatic artery. A selective arteriogram was performed and demonstrated a normal branching pattern. Tumor vascularity was identified. The cystic artery was identified. Again using an 035 angled Glidewire and a C2 glide catheter access was obtained to the right hepatic artery distal to the cystic artery. Selective arteriogram demonstrated tumor vascularity within this distribution. 4 cc of intra-arterial 1% lidocaine was infused. This was then followed by chemoembolic infusion of 100-300 micron doxorubicin LC beads. A total of 75 mg was administered within this arterial distribution. 3 cc of intra-arterial 1% lidocaine was then infused. After the superselective infusion was performed, the C2 glide catheter was removed. Then an arteriogram was performed of the right common femoral arteriotomy site. This demonstrated the vessel to be of normal caliber and without significant arterial vascular disease. Therefore the arteriotomy site was sealed with a Mynx device. The patient tolerated the procedure well and no immediate competitions were observed.
Contrast/Medications:
1. 10 cc 1% lidocaine for local anesthetic.
2. 3 mg Versed.
3. 100 mcg fentanyl.
4. 50 cc of Isovue-370.
5. 7 cc of 1% lidocaine used for intra-arterial infusion.
Complications: None.
Fluoroscopy time: Six minutes.
Conscious sedation: 40 minutes.