cknorr
New
I'm fairly new to coding and need to check if this is correct/ If I am billing correctly. Thank you in advance for your help!
36245
36247
36248
75726
75774
37243 x7
Q9967,C1894,C1760,C1887,C1769,C1876,C2616,C1769 X2,A4657
Procedure: RADIOEMBOLIZATION SIR PART 2
Type of Anesthesia
Moderate conscious sedation was administered with continuous monitoring. First dose by physician. 2% Lidocaine.
Pre-OP Diagnosis
Hepatocellular carcinoma
Post-OP Diagnosis
Same
Contrast
50 mL
Description of Procedure
1. Ultrasound-guided puncture right femoral artery
2. Superior mesenteric artery angiography
3. Splenic artery angiography
4. Common hepatic artery angiography
5. Selective left hepatic artery angiography
6. Subselective segment 4 hepatic artery angiography
7. Superselective segment 4 branch hepatic artery angiography
8. Yttrium-90 loaded resin spheres injection in hepatic segment 4
9. Right groin hemostasis with Mynx closure device
Findings of Procedure
Informed consent was obtained. Patient was placed supine on the procedure table and right groin was prepped and draped in standard sterile fashion. Skin infiltrated with 2% lidocaine. Utilizing real-time ultrasound guidance a 21-gauge micro puncture needle was advanced into
he right common femoral vein and exchanged for nested 3 and 5 French dilators and subsequently a 5 French sheath. A C2 Cobra catheter was advanced into the aorta and the SMA was selected and angiography was performed demonstrating opacification of the bowel however SMV was not seen well. Suction was then performed of the celiac artery and subsequently the splenic artery were angiography was performed demonstrating patent portal
vein. The common hepatic artery was then selected and angiography was performed delineating the right and left hepatic branches. Sub selection was then performed of the left hepatic artery and angiography was performed delineating the lateral medial branches. Sub selection then of the left hepatic artery and angiography was performed demonstrating tumor supply. Catheter was advanced into a segment 4 hepatic arterial branch where angiography demonstrated partial tumor enhancement. Catheter was then retracted into the segment 4 hepatic artery. Some arterial spasm was noted and a total of 600 mcg nitroglycerin was administered. Subsequently the SIR-Spheres were injected. Catheters were removed and right groin hemostasis with Mynx closure device. A sterile dressing was applied. Patient tolerated the procedure well without any complication.
Estimated Blood Loss 5 ml
Narrative/Description/Findings
Hepatic segment 4 radioembolization as above. Patient will proceed to nuclear medicine for SPECT imaging.
36245
36247
36248
75726
75774
37243 x7
Q9967,C1894,C1760,C1887,C1769,C1876,C2616,C1769 X2,A4657
Procedure: RADIOEMBOLIZATION SIR PART 2
Type of Anesthesia
Moderate conscious sedation was administered with continuous monitoring. First dose by physician. 2% Lidocaine.
Pre-OP Diagnosis
Hepatocellular carcinoma
Post-OP Diagnosis
Same
Contrast
50 mL
Description of Procedure
1. Ultrasound-guided puncture right femoral artery
2. Superior mesenteric artery angiography
3. Splenic artery angiography
4. Common hepatic artery angiography
5. Selective left hepatic artery angiography
6. Subselective segment 4 hepatic artery angiography
7. Superselective segment 4 branch hepatic artery angiography
8. Yttrium-90 loaded resin spheres injection in hepatic segment 4
9. Right groin hemostasis with Mynx closure device
Findings of Procedure
Informed consent was obtained. Patient was placed supine on the procedure table and right groin was prepped and draped in standard sterile fashion. Skin infiltrated with 2% lidocaine. Utilizing real-time ultrasound guidance a 21-gauge micro puncture needle was advanced into
he right common femoral vein and exchanged for nested 3 and 5 French dilators and subsequently a 5 French sheath. A C2 Cobra catheter was advanced into the aorta and the SMA was selected and angiography was performed demonstrating opacification of the bowel however SMV was not seen well. Suction was then performed of the celiac artery and subsequently the splenic artery were angiography was performed demonstrating patent portal
vein. The common hepatic artery was then selected and angiography was performed delineating the right and left hepatic branches. Sub selection was then performed of the left hepatic artery and angiography was performed delineating the lateral medial branches. Sub selection then of the left hepatic artery and angiography was performed demonstrating tumor supply. Catheter was advanced into a segment 4 hepatic arterial branch where angiography demonstrated partial tumor enhancement. Catheter was then retracted into the segment 4 hepatic artery. Some arterial spasm was noted and a total of 600 mcg nitroglycerin was administered. Subsequently the SIR-Spheres were injected. Catheters were removed and right groin hemostasis with Mynx closure device. A sterile dressing was applied. Patient tolerated the procedure well without any complication.
Estimated Blood Loss 5 ml
Narrative/Description/Findings
Hepatic segment 4 radioembolization as above. Patient will proceed to nuclear medicine for SPECT imaging.