iamlou
Networker
I'm not sure how to code this. Exam was done with a endometrial cavity balloon in place. Catheters were inserted, injections done, etc. Then the balloon was deflated 50% and the whole process was done again. Do I code the cath placements and injections twice? Here's the report and what I came up with:
HISTORY: female status post induced vaginal delivery of twin
gestation complicated by postpartum bleeding necessitating insertion of
endometrial cavity balloon. Emergent pelvic angiography requested.
PROCEDURES PERFORMED:
Pelvic angiography
IMAGING MODALITY UTILIZED:
Ultrasound and fluoroscopy
ACCESS SITE:
Right common femoral artery
CATHETER POSITION:
Distal abdominal aorta, left hypogastric artery, left uterine artery, right
hypogastric artery, right uterine artery
Under ultrasound guidance after achieving local
anesthesia with 1 percent lidocaine, the right common femoral artery was
accessed. Over a guidewire a 6 French sheath was inserted followed by
placement of a 4 French Omni Flush catheter placed in the caudal abdominal
aorta. AP pelvic angiography was performed. (75736) Subsequently the diagnostic
catheter was exchanged over a guidewire for a 4 French C2 glide catheter
which was negotiated into the left hypogastric artery. Injection was
performed (36246/75774). Catheter further advanced into the left uterine artery.
Superselective injections were performed in the LAO and AP projection (36248/75774).Injections were initially performed with the endometrium balloon inflated.
The C2 catheter was exchanged over guidewire for a 5 French Roberts
catheter which was formed across the aortic bifurcation, and repositioned
in the ipsilateral right hypogastric artery. Injections were performed in
the RAO projection (36248/75774). The catheter was subsequently advanced into the right
uterine artery. Superselective injections were performed with balloon
inflated (36248/75774). Subsequently the balloon was deflated by 50 percent by the
attending obstetrician who was present for the entire study. Repeat
injection was performed into the right uterine artery in the AP projection.
The catheter was then repositioned across the bifurcation into the left
uterine artery. Injection was performed with balloon deflated 50 percent.
The balloon was completely deflated by the attending obstetrician, and
repeat injection was performed into the left uterine artery. Catheter was
then repositioned across the bifurcation, and position in the right uterine
artery. Injection performed with complete balloon deflation.
There is no angiographic evidence for active extravasation. As such no
embolization was performed. The catheter was removed. Access site closed
using Starr close without incident. The endometrial cavity balloon was
reinflated by the attending obstetrician. Sterile dressing was applied.
THERE IS NO ACTIVE HEMORRHAGE IDENTIFIED.
I appreciate any opinions on this. THANK YOU!!
HISTORY: female status post induced vaginal delivery of twin
gestation complicated by postpartum bleeding necessitating insertion of
endometrial cavity balloon. Emergent pelvic angiography requested.
PROCEDURES PERFORMED:
Pelvic angiography
IMAGING MODALITY UTILIZED:
Ultrasound and fluoroscopy
ACCESS SITE:
Right common femoral artery
CATHETER POSITION:
Distal abdominal aorta, left hypogastric artery, left uterine artery, right
hypogastric artery, right uterine artery
Under ultrasound guidance after achieving local
anesthesia with 1 percent lidocaine, the right common femoral artery was
accessed. Over a guidewire a 6 French sheath was inserted followed by
placement of a 4 French Omni Flush catheter placed in the caudal abdominal
aorta. AP pelvic angiography was performed. (75736) Subsequently the diagnostic
catheter was exchanged over a guidewire for a 4 French C2 glide catheter
which was negotiated into the left hypogastric artery. Injection was
performed (36246/75774). Catheter further advanced into the left uterine artery.
Superselective injections were performed in the LAO and AP projection (36248/75774).Injections were initially performed with the endometrium balloon inflated.
The C2 catheter was exchanged over guidewire for a 5 French Roberts
catheter which was formed across the aortic bifurcation, and repositioned
in the ipsilateral right hypogastric artery. Injections were performed in
the RAO projection (36248/75774). The catheter was subsequently advanced into the right
uterine artery. Superselective injections were performed with balloon
inflated (36248/75774). Subsequently the balloon was deflated by 50 percent by the
attending obstetrician who was present for the entire study. Repeat
injection was performed into the right uterine artery in the AP projection.
The catheter was then repositioned across the bifurcation into the left
uterine artery. Injection was performed with balloon deflated 50 percent.
The balloon was completely deflated by the attending obstetrician, and
repeat injection was performed into the left uterine artery. Catheter was
then repositioned across the bifurcation, and position in the right uterine
artery. Injection performed with complete balloon deflation.
There is no angiographic evidence for active extravasation. As such no
embolization was performed. The catheter was removed. Access site closed
using Starr close without incident. The endometrial cavity balloon was
reinflated by the attending obstetrician. Sterile dressing was applied.
THERE IS NO ACTIVE HEMORRHAGE IDENTIFIED.
I appreciate any opinions on this. THANK YOU!!