Can we code the below procedure with
37205
36245
75960-26
75726-26
75625-26
Procedure. Aortogram. Celiac arteriogram. Celiac angioplasty
and stent placement.
Procedure.
Informed consent was obtained. The patient was prepped and draped
appropriately and after infiltration with local anesthesia the
left axillary artery was punctured with a micropuncture set and a
long 6-French sheath introduced. Through this an Omniflush
catheter was manipulated into the descending aorta and the sheath
further advanced. The Omni flush catheter was then positioned
just above the celiac axis and contrast injected with filming in
the lateral projection.
Findings.
Aortogram.
The aortogram shows two superior mesenteric artery stents which do
not overlap. The trailing end of the proximal stent is not in the
true aortic lumen. There is extensive calcification in the region
of the celiac axis and extending to 1 cm above it. There is a
large saucerized plaque across the origin of the celiac artery.
The celiac artery is not seen but some contrast does fill to the
celiac branches. No contrast enters the superior mesenteric
artery. The stents extend over a distance of 5 cm.
Celiac arteriogram.
The hepatic and splenic arteries fill but there is a 95% stenosis
in the right hepatic artery. The gastroduodenal is enlarged but
is not in continuity with the inferior pancreaticoduodenal artery.
The distal branch of the gastroduodenal artery fills some of the
duodenum and there is reconstitution of the ileocolic artery and
several mesenteric vessels. The amount of filling is poor. There
has been a previous bowel resection. Also filling is an isolated
middle colic artery which fills the left colic down to about the
sigmoid. The inferior mesenteric artery does not reconstitute.
Procedure.
The Omni flush catheter was exchanged for a Berenstein catheter
and a stiff Terumo wire used to probe the superior mesenteric
artery but this vessel could not be entered. The catheter was
then pulled back and the celiac artery entered followed by the
Berenstein catheter. An exchange is made over a Rosen wire for a
7 mm Palmaz Genesis stent 29 mm in length which was positioned
across the ostial stenosis with its trailing end into the aorta.
A slight waist where the stent passed through the aortic wall
calcium could not be completely eliminated but a 6-mm diameter was
achieved. A celiac arteriogram was performed before the stent was
placed.
Contrast injection after the procedure demonstrated good flow
through the celiac trunk via the stent. The celiac pressure which
previously had been 23 mm systolic now equalized with the aortic
pressure to demonstrate that the 110mm gradient had been removed.
Impression.
Status post SMA stent placement with occlusion of the superior
mesenteric artery. The mesenteric circulation is extensively
compromised with no inferior pancreaticoduodenal and no connection
save for via collaterals with the middle and left colic artery.
The IMA does not fill.
7 mm stent placement in a subtotal occlusion of the celiac trunk.
37205
36245
75960-26
75726-26
75625-26
Procedure. Aortogram. Celiac arteriogram. Celiac angioplasty
and stent placement.
Procedure.
Informed consent was obtained. The patient was prepped and draped
appropriately and after infiltration with local anesthesia the
left axillary artery was punctured with a micropuncture set and a
long 6-French sheath introduced. Through this an Omniflush
catheter was manipulated into the descending aorta and the sheath
further advanced. The Omni flush catheter was then positioned
just above the celiac axis and contrast injected with filming in
the lateral projection.
Findings.
Aortogram.
The aortogram shows two superior mesenteric artery stents which do
not overlap. The trailing end of the proximal stent is not in the
true aortic lumen. There is extensive calcification in the region
of the celiac axis and extending to 1 cm above it. There is a
large saucerized plaque across the origin of the celiac artery.
The celiac artery is not seen but some contrast does fill to the
celiac branches. No contrast enters the superior mesenteric
artery. The stents extend over a distance of 5 cm.
Celiac arteriogram.
The hepatic and splenic arteries fill but there is a 95% stenosis
in the right hepatic artery. The gastroduodenal is enlarged but
is not in continuity with the inferior pancreaticoduodenal artery.
The distal branch of the gastroduodenal artery fills some of the
duodenum and there is reconstitution of the ileocolic artery and
several mesenteric vessels. The amount of filling is poor. There
has been a previous bowel resection. Also filling is an isolated
middle colic artery which fills the left colic down to about the
sigmoid. The inferior mesenteric artery does not reconstitute.
Procedure.
The Omni flush catheter was exchanged for a Berenstein catheter
and a stiff Terumo wire used to probe the superior mesenteric
artery but this vessel could not be entered. The catheter was
then pulled back and the celiac artery entered followed by the
Berenstein catheter. An exchange is made over a Rosen wire for a
7 mm Palmaz Genesis stent 29 mm in length which was positioned
across the ostial stenosis with its trailing end into the aorta.
A slight waist where the stent passed through the aortic wall
calcium could not be completely eliminated but a 6-mm diameter was
achieved. A celiac arteriogram was performed before the stent was
placed.
Contrast injection after the procedure demonstrated good flow
through the celiac trunk via the stent. The celiac pressure which
previously had been 23 mm systolic now equalized with the aortic
pressure to demonstrate that the 110mm gradient had been removed.
Impression.
Status post SMA stent placement with occlusion of the superior
mesenteric artery. The mesenteric circulation is extensively
compromised with no inferior pancreaticoduodenal and no connection
save for via collaterals with the middle and left colic artery.
The IMA does not fill.
7 mm stent placement in a subtotal occlusion of the celiac trunk.
