Wiki Repost-spinal angios/embolizations

[margaret fahy]

Hi...For some reason, my message keeps going away...I'm trying again.
QUESTIONS: Are the spinal angios listed below diagnostic, given that there was an MRA two days prior? What about the super-selective angio? Dr. doesn't name any vesssels...so wasn't sure; I coded this as a bilateral embo.
Here are my codes so far:
36246-75710-59-com.fem.art; 36245-59 X8; 75705-59 X8; 61624 X2-bilateral; 75894 X2; 75898 X2. Can I get some input on these codes? Thanks so much....Margie.

PROCEDURE: Embolization of complex paraspinal arteriovenous
malformation.
HISTORY: 12-year-old boy with history of CLOVES syndrome and
progressive lower extremity weakness over the past month with
acute worsening of bilateral lower extremity weakness and new
bowel incontinence a few days ago.
VESSELS SELECTED:
Right L1, L2, L3, L4 segmental arteries
Left L1, L2, L3, L4 segmental arteries
Right femoral artery
COMPLICATIONS: None.
After informed consent the patient was brought into the
angiography suite and placed supine on the angiographic table.
The Interventional Radiology attending Dr. obtained
access to the right femoral artery using ultrasound guidance and
placed a 10-cm 6-French sheath. An HS-1 catheter was advanced
into the aorta over and 0.038-inch Glidewire. Using an HS-1
catheter, right L1, L2, L3, L4 and left L1, L2, L3, L4 segmental
arteries were selected for angiography.
FINDINGS:
RIGHT L1, L2, L3, L4 SEGMENTAL ARTERIES AND LEFT L1, L2, L3, L4
SEGMENTAL ARTERIES INJECTIONS:
There is a large paraspinal vascular malformation with multiple
arterial feeders arising from bilateral L2, L3 and L4 segmental
arteries. Small-vessel arteriovenous communications and multiple
arteriovenous fistulas are noted with large draining veins in and
around the spinal canal; these large draining veins empty
directly into the inferior vena cava. This constellation of
findings is consistent with a complex paraspinal arteriovenous
malformation.
RIGHT FEMORAL ARTERY INJECTION:
At the end of the procedure the right toe O2 saturation was 10%
lower than at the hand.
Right common femoral artery and visualized portions of the
superficial femoral artery and profunda femoris are patent. There
was minor focal spasm near the tip of the sheath in the external
iliac artery. After the sheath was removed, the right foot O2
saturation normalized.
*****************************************************************
*************************************************
An intervention was performed as follows.
INTERVENTION:
A right L3 pedicle was selected using a Synchro 2 microwire and
SL-10 microcatheter with road map guidance and continuous
fluoroscopic monitoring. Super selective angiography of this
pedicle shows filling of vascular malformation and no
anterior/posterior spinal artery enhancement. The pedicle was
embolized using n-butyl cyanoacrylate (n-BCA) glue.
Postembolization angiography shows stagnation of flow through
this pedicle.
Using a similar approach, one additional right L3 pedicle, one
left L3 pedicle, 2 right L2 pedicles and 2 left L2 pedicles were
selected and embolized with n-BCA glue. Postembolization
angiography shows significant decrease in filling of the vascular
malformation with stagnation of flow through the draining veins.
At the completion of the procedure, the catheter and sheath were
removed by the IR service and hemostasis in the right groin
obtained by manual compression for 15 minutes under ultrasound
guidance and right foot post oxygenation monitoring.
No new neurological deficits or complications were encountered
during or immediately following the procedure.
*****************************************************************
*************************************************
IMPRESSION

Successful endovascular NBCA glue embolization complex paraspinal
arteriovenous malformation.
Dr. was present during the whole procedure and is
personally responsible for its interpretation.




Result History
IR ANGIO SPINAL ARTERY on 3/7/14 - Order Result History Report.

 

[dpeoples]

I see:
61624/75894/75898
36245x8

I would need to know the results of the mra to determine if 75705 (x8) should also be coded.

I would not code 36246/75710 for angiography of the access site.

HTH

 

[margaret fahy]

Dan,
Okay....so just one unit of 61624...you're saying this is one operative field...even though it's bilateral...i'm looking at it again now, and I see what you're saying....I was worried that i was wrong to code just one 61624, especially as it is bilateral and dr. says...using a similar approach...but it is just one malformation...can you confirm...one operative field....right?
And you're also saying that

as dr. does not give a finding for each angiography, then you'd not code for the rs&i? And if you did code for the RS&I, is it 9 because of the superselective one?
Again, for the Femoral, I thought I had to code it...but I guess I was wrong.

If you could address my two questions above, I'd really appreciate it....

Thanks so much....You're the absolute best.
Peace..
Margie

 

[margaret fahy]

Oh...Just read it again...now I understand....you said the MRA...sorry it's late, and I'm tired.... Here it is....
I would say that as dr. recommended discussion with neurointerventional radiology with consideration of catheter angiography, that I'd then think the angiographies done prior to the embo were diagnostic....what do you think?
MRA:
Overall the appearance of the MRA images is consistent with that
of abnormal arterial and venous channels with arteriovenous
shunting in the lower thoracic and entire lumbar spinal canal.
The arterial supply comes from multiple enlarged lumbar arteries
from the abdominal aorta, most prominent at the L2-4 levels,
which feed into the markedly dilated vessels within the spinal
canal primarily through dilated radiculomedullary arterial
branches, although innumerable dilated vascular structures are
present in this region. There are also markedly enlarged draining
veins draining into the left common iliac vein and through
bilateral lumbar veins into large bilateral paraspinal veins in
the chest. Additional, smaller caliber venous channels draining
the enlarged intraspinal vessels are seen coursing into the
inferior vena cava.

IMPRESSION


Markedly dilated vessels in the lower thoracic and lumbar spinal
canal with arteriovenous shunting and with compression of the
conus medullaris and cauda equina, as described in detail. It is
difficult to confidently determine whether this represents an
arteriovenous malformation, an arteriovenous fistula, or a
combination thereof. There are multiple large feeding arteries
arising from the abdominal aorta and multiple large veins
draining into the left common iliac vein, the inferior vena cava,
and bilateral upper lumbar veins draining into prominent
intrathoracic paraspinal veins. Recommend discussion with
neurointerventional radiology with consideration of catheter
angiography.