Wiki Resubmitting....any opinions appreciated. Angio w/embolization

Create Wiki
I

iamlou

Networker
Messages
67
Location
Sherrill, NY
Best answers
0
Can someone please help me with this? It seems the more I look at it, the more codes I come up with.

PROCEDURES PERFORMED:
Pelvic angiography, right common femoral artery pseudoaneurysm
embolization
IMAGING MODALITY UTILIZED:
Ultrasound and fluoroscopy
ACCESS SITE:
Left common femoral artery
CATHETER POSITION:
Abdominal aorta, right external iliac artery, right common femoral artery,
right superficial femoral artery
CONTRAST UTILIZED: Visipaque 320
TECHNIQUE: Under ultrasound guidance, after achieving local anesthesia, the left groin
common femoral artery was accessed in retrograde fashion. A 5 French
sheath was inserted followed by placement of a 4 French Omni Flush
catheter. Omni Flush catheter was placed at the aortic bifurcation. Pelvic
angiography was performed. There is marked tortuosity of the iliac inflow
vessels. Subsequently the catheter was exchanged for a 5 French Reuter
catheter which was positioned across the aortic bifurcation into the right
common iliac artery. Injections were performed. Catheter was exchanged over
a guidewire for a 4 French straight catheter which was positioned in the
right external iliac artery. Superselective injections were performed in
the AP, LAO and RAO projection. There is a focal 3.3 cm pseudoaneurysm that
projects off the distal right common femoral artery.
Endovascular management was elected.
Due to the marked tortuosity of the iliac inflow vessels, positioning of
the sheath across the bifurcation was prohibitive. As such, a coaxial 3
French renegade catheter was placed through the 4 French straight glide
catheter which was positioned in the distal right external iliac artery.
Superselective injection performed. Catheter was further advanced across a
short neck of the pseudoaneurysm, into the pseudoaneurysm. Subsequently the
pseudoaneurysm was embolized using detachable 0.18 inch microcoils
(interlock). Total of 14 coils were utilized as follows: Two-10 mm x 30 mm,
two-8 mm x 20 mm, five-12 x 30 mm, Four-14 x 30 mm. The final coil was a 5
mm x 80 mm detachable coil which was placed at the very apex of the
aneurysm subjacent to the very short wide neck. Contrast was injected, and
demonstrates no significant filling of the aneurysm. Catheter removed.
Sheath removed. Access site closed using Minx.
FINDINGS:
3.3 cm right common femoral artery pseudoaneurysm treated with multiple
detachable 0.018 inch interlock coils as described above. The right
profunda femoral artery is patent. The right and left common iliac artery
and external iliac arteries are patent. There is marked tortuosity of the
iliac inflow bilaterally. The right and left hypogastric arteries are
patent. Viewed portion of the right proximal thigh infrainguinal runoff
graft appears patent.

This is what I came up with: 37242 for the embolization, 75736 x2 for the iliac angiograms, 36247 for the cath placement in the SFA, and 75774 for the injections in the AP, LAO and RAO projection. Am I close? I get so confused with the pelvic angios.

Thanks for any and all input!
 
iamlou said:
Can someone please help me with this? It seems the more I look at it, the more codes I come up with.

PROCEDURES PERFORMED:
Pelvic angiography, right common femoral artery pseudoaneurysm
embolization
IMAGING MODALITY UTILIZED:
Ultrasound and fluoroscopy
ACCESS SITE:
Left common femoral artery
CATHETER POSITION:
Abdominal aorta, right external iliac artery, right common femoral artery,
right superficial femoral artery
CONTRAST UTILIZED: Visipaque 320
TECHNIQUE: Under ultrasound guidance, after achieving local anesthesia, the left groin
common femoral artery was accessed in retrograde fashion. A 5 French
sheath was inserted followed by placement of a 4 French Omni Flush
catheter. Omni Flush catheter was placed at the aortic bifurcation. Pelvic
angiography was performed. There is marked tortuosity of the iliac inflow
vessels. Subsequently the catheter was exchanged for a 5 French Reuter
catheter which was positioned across the aortic bifurcation into the right
common iliac artery. Injections were performed. Catheter was exchanged over
a guidewire for a 4 French straight catheter which was positioned in the
right external iliac artery. Superselective injections were performed in
the AP, LAO and RAO projection. There is a focal 3.3 cm pseudoaneurysm that
projects off the distal right common femoral artery.
Endovascular management was elected.
Due to the marked tortuosity of the iliac inflow vessels, positioning of
the sheath across the bifurcation was prohibitive. As such, a coaxial 3
French renegade catheter was placed through the 4 French straight glide
catheter which was positioned in the distal right external iliac artery.
Superselective injection performed. Catheter was further advanced across a
short neck of the pseudoaneurysm, into the pseudoaneurysm. Subsequently the
pseudoaneurysm was embolized using detachable 0.18 inch microcoils
(interlock). Total of 14 coils were utilized as follows: Two-10 mm x 30 mm,
two-8 mm x 20 mm, five-12 x 30 mm, Four-14 x 30 mm. The final coil was a 5
mm x 80 mm detachable coil which was placed at the very apex of the
aneurysm subjacent to the very short wide neck. Contrast was injected, and
demonstrates no significant filling of the aneurysm. Catheter removed.
Sheath removed. Access site closed using Minx.
FINDINGS:
3.3 cm right common femoral artery pseudoaneurysm treated with multiple
detachable 0.018 inch interlock coils as described above. The right
profunda femoral artery is patent. The right and left common iliac artery
and external iliac arteries are patent. There is marked tortuosity of the
iliac inflow bilaterally. The right and left hypogastric arteries are
patent. Viewed portion of the right proximal thigh infrainguinal runoff
graft appears patent.

This is what I came up with: 37242 for the embolization, 75736 x2 for the iliac angiograms, 36247 for the cath placement in the SFA, and 75774 for the injections in the AP, LAO and RAO projection. Am I close? I get so confused with the pelvic angios.

Thanks for any and all input!
Click to expand...

I question whether the angiographies were "diagnostic". It seems the condition was probably known as the findings do not suggest a subsequent decision to treat was made. None the less, I can't be sure so:

37242 for the embolization
36246 for catheter selection of RT external iliac
75710 for the rt lower extremity.

I would not code 75774 because there is insufficient, separately identifiable interpretation of the "superselective injections. I also would not code 75736 becuase that code is for selective angiography of the internal iliacs only (not external).

(made the appropriate corrections)

HTH :)
 
Last edited:
Where in the dictation other than Catheter Position does it state a catheter was in the SFA...I must be blind, I can't see it!
 
You must log in or register to reply here.
Top