RJROBER
New
I am getting some push back on my coding for the below and would love a second opinion on the anterior segment hepatic lobe selection. I was under the impression the anterior segment was an intrahepatic branch, but I could be mistaken. LHA is of normal anatomy. Thanks!
Procedure: Y. 90 radio embolization.
Clinical history: Rectal cancer with liver metastases.
Fluoroscopy time: 35 minutes.
Contrast volume: 120 mL Isovue-370.
Technique: After thorough explanation of the risks and benefits informed written consent
was obtained. The patient was placed on fluoroscopy table and the right groin prepped and
draped in the usual sterile fashion. Local anesthesia was administered using one percent
Xylocaine. Conscious sedation was achieved for 2 hours using the above medications.
Using a micropuncture needle the right common femoral artery was accessed and a guidewire advanced centrally under fluoroscopic guidance. 5.5 French vascular sheath was advanced over the wire into the artery. A 5 French Cobra catheter was advanced into the abdominal aorta and used to select the superior mesenteric artery. Selective arteriography was performed. A microcatheter was then used to select the replaced right hepatic artery. Selective arteriography was performed. The microcatheter was manipulated into the anterior segment of the right hepatic lobe. Selective arteriography was performed. Coned beam CT was performed and three-dimensional images were reconstructed and evaluated on a separate workstation. Next the microcatheter was used to select the left hepatic artery. Selective arteriography was performed. Catheter was then manipulated into and esophageal branch and selective arteriography performed. Coil embolization was then performed. Check arteriography was performed. The microcatheter was then pulled back into the main left hepatic artery. Radio embolization was performed. Intermittent arteriography was performed to ensure antegrade flow. The microcatheter was then removed. 5 French catheter was removed. A right femoral arteriogram was performed through the existing sheath. The sheath was pulled and hemostasis obtained using a Starr close device. The patient tolerated this procedure well. There are no immediate complications.
Findings: Selective arteriography of the superior mesenteric artery demonstrate a replaced hepatic artery. Selective arteriography of the anterior branch of the right hepatic artery demonstrates tumor blush. There is an esophageal branch arising from the
left hepatic artery that supplies the distal esophagus and gastric cardiac region. There is no flow within this artery postembolization. The prescribed dose was 0.5 gigabecquerel (13.5 mCi). The drawn dose was 0.55 gigabecquerel (40.8 mCi). The delivered dose was 0.48 gigabecquerel (13 mCi). This equals 87.8 percent of the drawn dose and 96.3 percent of the prescribed dose. There was persistent antegrade flow during delivery.
Impression: Successful Y. 90 radio embolization as described.
75726 (SMA)
36247, 75774 (anterior segment right hepatic lobe)
76377 (CT)
36247, 75726 (LHA)
36248, 75774 (Esophageal branch)
R. Roberts, CPC
Op/Provider Coder 2
Procedure: Y. 90 radio embolization.
Clinical history: Rectal cancer with liver metastases.
Fluoroscopy time: 35 minutes.
Contrast volume: 120 mL Isovue-370.
Technique: After thorough explanation of the risks and benefits informed written consent
was obtained. The patient was placed on fluoroscopy table and the right groin prepped and
draped in the usual sterile fashion. Local anesthesia was administered using one percent
Xylocaine. Conscious sedation was achieved for 2 hours using the above medications.
Using a micropuncture needle the right common femoral artery was accessed and a guidewire advanced centrally under fluoroscopic guidance. 5.5 French vascular sheath was advanced over the wire into the artery. A 5 French Cobra catheter was advanced into the abdominal aorta and used to select the superior mesenteric artery. Selective arteriography was performed. A microcatheter was then used to select the replaced right hepatic artery. Selective arteriography was performed. The microcatheter was manipulated into the anterior segment of the right hepatic lobe. Selective arteriography was performed. Coned beam CT was performed and three-dimensional images were reconstructed and evaluated on a separate workstation. Next the microcatheter was used to select the left hepatic artery. Selective arteriography was performed. Catheter was then manipulated into and esophageal branch and selective arteriography performed. Coil embolization was then performed. Check arteriography was performed. The microcatheter was then pulled back into the main left hepatic artery. Radio embolization was performed. Intermittent arteriography was performed to ensure antegrade flow. The microcatheter was then removed. 5 French catheter was removed. A right femoral arteriogram was performed through the existing sheath. The sheath was pulled and hemostasis obtained using a Starr close device. The patient tolerated this procedure well. There are no immediate complications.
Findings: Selective arteriography of the superior mesenteric artery demonstrate a replaced hepatic artery. Selective arteriography of the anterior branch of the right hepatic artery demonstrates tumor blush. There is an esophageal branch arising from the
left hepatic artery that supplies the distal esophagus and gastric cardiac region. There is no flow within this artery postembolization. The prescribed dose was 0.5 gigabecquerel (13.5 mCi). The drawn dose was 0.55 gigabecquerel (40.8 mCi). The delivered dose was 0.48 gigabecquerel (13 mCi). This equals 87.8 percent of the drawn dose and 96.3 percent of the prescribed dose. There was persistent antegrade flow during delivery.
Impression: Successful Y. 90 radio embolization as described.
75726 (SMA)
36247, 75774 (anterior segment right hepatic lobe)
76377 (CT)
36247, 75726 (LHA)
36248, 75774 (Esophageal branch)
R. Roberts, CPC
Op/Provider Coder 2
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