suela923@aol.com
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Hello! I have a few questions on this one!
I billed:
75726- Celiac,
75726 - SMA
75774 - Gastoduo, Pancreatio, Pancreatio, 3rd order SMA, 3rd order SMA
36247 x 2 and 36248 x 2
37244
What confuses me is the doctor's findings: He gives findings for the celiac, gastroduodenal and then again for a mid branch of gastoduodenal and a distal branch. I think he means a mid and distal pancreatiocoduodenal as per his dictation under Technique. The tech that trained me insists it doesn't matter since they are all 3rd order branches. The other thing is she was scrubbed in the case and insists he wasn't in 3rd order branches of the SMA. I feel that he documented he was so that is the way I need to bill it. I did address it with the doctor and he did not change his dictation to reflect that he wasn't in these 3rd orders.
Also should it be 36247 x 2 and 36248 x 3. Again he states things one way under technique and another under findings. I read it that he embolized in the gastoduo artery after he did the angiogram when I read it under technique but in findings it sounds like he went back to the gastro which would me another cath placement. HELP!?!? Thanks!!
IR EMBO, ARTERY OR VEIN FOR HEMORRHAGE OR LYMPH EXTRAV 06/12/2014
HISTORY: Active duodenal diverticular bleeding.
Technique: Informed consent was obtained from the patient's daughter. A time out was performed. The patient was prepped and draped in the usual sterile fashion. 2% lidocaine was used to anesthetize the skin in the right inguinal area. A micropuncture set was used to gain access to the right common femoral artery. A 6-French sheath was placed. Through the sheath, a 5-French C2 catheter was used to select the celiac artery and an arteriogram was performed. The catheter was then used to select the gastroduodenal artery as well as two separate and distinct vessels of a portion of the pancreaticoduodenal arcade. Angiograms were performed in each of these locations. Additional superior mesenteric artery and 2 distinct third order proximal SMA branches were selected and injected. Angiograms were performed in all of these locations. Three embolization coils were placed in the mid to proximal gastroduodenal artery. The C2 catheter was used to select a portion of the pancreaticoduodenal arcade and with the aid of a microcatheter, 3 embolization coils were placed within the arcade. Postembolization angiography was performed.
At the end of the procedure, the common femoral artery puncture site was closed using an Angio-Seal device.
FINDINGS:
Initial celiac arteriogram shows no evidence of active bleeding. Separate injection of the proximal gastroduodenal artery revealed active bleeding off towards the right side laterally. A separate injection and a mid branch of the gastroduodenal artery showed no evidence of active bleeding. A separate injection of a distal branch of the gastroduodenal artery fail to show active bleeding.
Following coiling of the gastroduodenal artery and repeat injection was performed which showed no evidence of active bleeding.
And injection of the proximal superior mesenteric artery showed partial visualization of the proximal branches and no active bleeding. A third order branch beyond the origin the superior mesenteric artery was injected and this showed a portion of the pancreaticoduodenal arcade. No active bleeding was seen in this area. A second third order branch from the proximal superior mesenteric artery was injected and again no active bleeding was seen in the region of the pancreatic head.
The catheter was redirected back to the gastroduodenal artery and injection of a proximal branch arising from this vessel opacified the pancreaticoduodenal arcade and small vessels supplying the area of initially visualized active bleeding. With the catheter in this position and using a more distal embolization was achieved using 3 embolization coils. Post embolization angiography was then obtained and showed no evidence of bleeding.
Result Impression
Successful embolization the gastroduodenal artery distally as well as portions of the pancreaticoduodenal arcade as described above.
I billed:
75726- Celiac,
75726 - SMA
75774 - Gastoduo, Pancreatio, Pancreatio, 3rd order SMA, 3rd order SMA
36247 x 2 and 36248 x 2
37244
What confuses me is the doctor's findings: He gives findings for the celiac, gastroduodenal and then again for a mid branch of gastoduodenal and a distal branch. I think he means a mid and distal pancreatiocoduodenal as per his dictation under Technique. The tech that trained me insists it doesn't matter since they are all 3rd order branches. The other thing is she was scrubbed in the case and insists he wasn't in 3rd order branches of the SMA. I feel that he documented he was so that is the way I need to bill it. I did address it with the doctor and he did not change his dictation to reflect that he wasn't in these 3rd orders.
Also should it be 36247 x 2 and 36248 x 3. Again he states things one way under technique and another under findings. I read it that he embolized in the gastoduo artery after he did the angiogram when I read it under technique but in findings it sounds like he went back to the gastro which would me another cath placement. HELP!?!? Thanks!!
IR EMBO, ARTERY OR VEIN FOR HEMORRHAGE OR LYMPH EXTRAV 06/12/2014
HISTORY: Active duodenal diverticular bleeding.
Technique: Informed consent was obtained from the patient's daughter. A time out was performed. The patient was prepped and draped in the usual sterile fashion. 2% lidocaine was used to anesthetize the skin in the right inguinal area. A micropuncture set was used to gain access to the right common femoral artery. A 6-French sheath was placed. Through the sheath, a 5-French C2 catheter was used to select the celiac artery and an arteriogram was performed. The catheter was then used to select the gastroduodenal artery as well as two separate and distinct vessels of a portion of the pancreaticoduodenal arcade. Angiograms were performed in each of these locations. Additional superior mesenteric artery and 2 distinct third order proximal SMA branches were selected and injected. Angiograms were performed in all of these locations. Three embolization coils were placed in the mid to proximal gastroduodenal artery. The C2 catheter was used to select a portion of the pancreaticoduodenal arcade and with the aid of a microcatheter, 3 embolization coils were placed within the arcade. Postembolization angiography was performed.
At the end of the procedure, the common femoral artery puncture site was closed using an Angio-Seal device.
FINDINGS:
Initial celiac arteriogram shows no evidence of active bleeding. Separate injection of the proximal gastroduodenal artery revealed active bleeding off towards the right side laterally. A separate injection and a mid branch of the gastroduodenal artery showed no evidence of active bleeding. A separate injection of a distal branch of the gastroduodenal artery fail to show active bleeding.
Following coiling of the gastroduodenal artery and repeat injection was performed which showed no evidence of active bleeding.
And injection of the proximal superior mesenteric artery showed partial visualization of the proximal branches and no active bleeding. A third order branch beyond the origin the superior mesenteric artery was injected and this showed a portion of the pancreaticoduodenal arcade. No active bleeding was seen in this area. A second third order branch from the proximal superior mesenteric artery was injected and again no active bleeding was seen in the region of the pancreatic head.
The catheter was redirected back to the gastroduodenal artery and injection of a proximal branch arising from this vessel opacified the pancreaticoduodenal arcade and small vessels supplying the area of initially visualized active bleeding. With the catheter in this position and using a more distal embolization was achieved using 3 embolization coils. Post embolization angiography was then obtained and showed no evidence of bleeding.
Result Impression
Successful embolization the gastroduodenal artery distally as well as portions of the pancreaticoduodenal arcade as described above.
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