margaret fahy
Guru
Hey Guys,
Is 61623 included in 61624? CSI book doesn't state so, and they're not bundled.
Procedure is below....can someone tell me if I am to bill 61623 when it is done in same session as 61624?
PROCEDURE: Cerebral angiogram, left internal carotid artery
balloon occlusion test, and embolization of left
internal carotid artery.
HISTORY: 17-year-old with traumatic left cervical internal
carotid artery pseudoaneurysm.
VESSELS SELECTED:
Left internal carotid artery
Left common carotid artery
TECHNIQUE:
After informed consent the patient was brought into the
angiography suite and placed supine on the angiographic table.
The right groin was prepped and draped using sterile technique.
The CHOP Interventional Radiology service, Dr. obtained
access to the right femoral artery using ultrasound guidance and
placed a 6-French sheath. Using an 0.038" Glide Wire and 6-French
Envoy catheter, the above vessels were selectively catheterized
for angiography
FINDINGS:
LEFT COMMON CAROTID ARTERY AND LEFT INTERNAL CAROTID ARTERY
INJECTIONS, HEAD AND NECK VIEWS: Redemonstrated left cervical
internal carotid artery (ICA) pseudoaneurysm extending from the
proximal cervical ICA to the skull base, unchanged compared to
cerebral angiogram of 2/13/2015. Unremarkable angiographic
appearance of the left supraclinoid internal carotid artery, left
middle cerebral artery, and left anterior cerebral artery. The
angiogram has normal parenchymal and venous phases. No evidence
of high grade focal intracranial stenosis or vascular
malformation.
An intervention was performed as follows.
INTERVENTION:
BALLOON OCCLUSION TEST:
The patient was fully anticoagulated with IV heparin, confirmed
by ACT levels, throughout balloon occlusion test. The 6F Envoy
catheter was positioned in the proximal left cervical ICA. An
Expedion 0.010 wire and Hyperform 7 x 7 mm balloon were prepared
using standard technique and advanced into the proximal left
cervical internal carotid artery just proximal to the
pseudoaneurysm. Under real-time fluoroscopy, the balloon was
inflated. Gentle injection through the guide catheter confirmed
occlusion of the left internal carotid artery. Serial neurologic
exams were performed every minute for 20 minutes. The patient's
neurologic exam was unchanged during 20 minutes of left internal
carotid artery balloon occlusion. Intermittent fluoroscopy was
performed to confirm that the balloon was inflated during the
procedure. At the conclusion of the ballon occlusion test, the
ballon catheter was deflated and removed. Neurological
examination following the balloon occlusion test remained normal.
LEFT INTERNAL CAROTID ARTERY EMBOLIZATION:
The left cervical ICA pseudoaneurysm selected with a SL-10
microcatheter and Synchro-2 microwire system. Embolization was
performed across the pseudoaneurysm into the proximal left
cervical ICA, proximal to the pseudoaneurysm. Platinum coils
(delivered through the SL-10 microcatheter) and Amplatzer
vascular plugs (delivered through the 6-French Envoy catheter)
were deployed under continuous fluoroscopic guidance.
The following coils and Amplatzer vascular plugs were deployed:
Target 360 Standard 15 mm x 40 cm
Target 360 Standard 15 mm x 40 cm
Target 360 Standard 12 mm x 30 cm
Target 360 Standard 12 mm x 30 cm
Target 360 Standard 10 mm x 30 cm
Target 360 Standard 10 mm x 30 cm
Amplatzer vascular plug 6mm
Amplatzer vascular plug 6mm
Target 360 Soft 5 mm x 15 cm
Target 360 Ultra 3 mm x 8 cm
Target 360 Ultra 3 mm x 8 cm
Target 360 Soft 3 mm x 10 cm
Post embolization angiography demonstrated no antegrade flow
through the embolized portions of the left ICA. There is
antegrade filling of the supraclinoid ICA via ECA-ophthalmic
collaterals. There is minimal contrast opacification of the left
cavernous ICA, which will most likely be occluded over time due
to slow flow.
At the completion of the procedure, the catheter and sheath were
removed and hemostasis in the right groin obtained by manual
compression for 20 minutes.
No new neurological deficits or complications were encountered
during or immediately following the procedure.
IMPRESSION
Successful occlusion of the left internal carotid artery after
negative balloon occlusion test as detailed.
Is 61623 included in 61624? CSI book doesn't state so, and they're not bundled.
Procedure is below....can someone tell me if I am to bill 61623 when it is done in same session as 61624?
PROCEDURE: Cerebral angiogram, left internal carotid artery
balloon occlusion test, and embolization of left
internal carotid artery.
HISTORY: 17-year-old with traumatic left cervical internal
carotid artery pseudoaneurysm.
VESSELS SELECTED:
Left internal carotid artery
Left common carotid artery
TECHNIQUE:
After informed consent the patient was brought into the
angiography suite and placed supine on the angiographic table.
The right groin was prepped and draped using sterile technique.
The CHOP Interventional Radiology service, Dr. obtained
access to the right femoral artery using ultrasound guidance and
placed a 6-French sheath. Using an 0.038" Glide Wire and 6-French
Envoy catheter, the above vessels were selectively catheterized
for angiography
FINDINGS:
LEFT COMMON CAROTID ARTERY AND LEFT INTERNAL CAROTID ARTERY
INJECTIONS, HEAD AND NECK VIEWS: Redemonstrated left cervical
internal carotid artery (ICA) pseudoaneurysm extending from the
proximal cervical ICA to the skull base, unchanged compared to
cerebral angiogram of 2/13/2015. Unremarkable angiographic
appearance of the left supraclinoid internal carotid artery, left
middle cerebral artery, and left anterior cerebral artery. The
angiogram has normal parenchymal and venous phases. No evidence
of high grade focal intracranial stenosis or vascular
malformation.
An intervention was performed as follows.
INTERVENTION:
BALLOON OCCLUSION TEST:
The patient was fully anticoagulated with IV heparin, confirmed
by ACT levels, throughout balloon occlusion test. The 6F Envoy
catheter was positioned in the proximal left cervical ICA. An
Expedion 0.010 wire and Hyperform 7 x 7 mm balloon were prepared
using standard technique and advanced into the proximal left
cervical internal carotid artery just proximal to the
pseudoaneurysm. Under real-time fluoroscopy, the balloon was
inflated. Gentle injection through the guide catheter confirmed
occlusion of the left internal carotid artery. Serial neurologic
exams were performed every minute for 20 minutes. The patient's
neurologic exam was unchanged during 20 minutes of left internal
carotid artery balloon occlusion. Intermittent fluoroscopy was
performed to confirm that the balloon was inflated during the
procedure. At the conclusion of the ballon occlusion test, the
ballon catheter was deflated and removed. Neurological
examination following the balloon occlusion test remained normal.
LEFT INTERNAL CAROTID ARTERY EMBOLIZATION:
The left cervical ICA pseudoaneurysm selected with a SL-10
microcatheter and Synchro-2 microwire system. Embolization was
performed across the pseudoaneurysm into the proximal left
cervical ICA, proximal to the pseudoaneurysm. Platinum coils
(delivered through the SL-10 microcatheter) and Amplatzer
vascular plugs (delivered through the 6-French Envoy catheter)
were deployed under continuous fluoroscopic guidance.
The following coils and Amplatzer vascular plugs were deployed:
Target 360 Standard 15 mm x 40 cm
Target 360 Standard 15 mm x 40 cm
Target 360 Standard 12 mm x 30 cm
Target 360 Standard 12 mm x 30 cm
Target 360 Standard 10 mm x 30 cm
Target 360 Standard 10 mm x 30 cm
Amplatzer vascular plug 6mm
Amplatzer vascular plug 6mm
Target 360 Soft 5 mm x 15 cm
Target 360 Ultra 3 mm x 8 cm
Target 360 Ultra 3 mm x 8 cm
Target 360 Soft 3 mm x 10 cm
Post embolization angiography demonstrated no antegrade flow
through the embolized portions of the left ICA. There is
antegrade filling of the supraclinoid ICA via ECA-ophthalmic
collaterals. There is minimal contrast opacification of the left
cavernous ICA, which will most likely be occluded over time due
to slow flow.
At the completion of the procedure, the catheter and sheath were
removed and hemostasis in the right groin obtained by manual
compression for 20 minutes.
No new neurological deficits or complications were encountered
during or immediately following the procedure.
IMPRESSION
Successful occlusion of the left internal carotid artery after
negative balloon occlusion test as detailed.