Wiki Code only 37242?

iamlou

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Hello,

These new codes for embolizations are still confusing me. What's confusing is how to determine whether the cath placements and diagnostics are ok to code separately. Can someone please help me decide if they are in this report?

PROCEDURES PERFORMED:
Pelvic angiography, cone beam CT angiography and fusion, right hypogastric
artery embolization
IMAGING MODALITY UTILIZED:
Ultrasound and cone beam CT, fluoroscopy
ACCESS SITE:
Right common femoral artery
CATHETER POSITION:
Right internal iliac artery, right superior gluteal artery, right inferior
gluteal artery
CONTRAST UTILIZED: Nonionic contrast utilized.
Under ultrasound guidance, after achieving local
anesthesia with 1 percent lidocaine, the the right common femoral artery
was accessed. A 6 French sheath was inserted.
Cone beam CT was performed. Images were fused with angio dated March 4,
2014. Vessel overlay cone beam CTA fusion with fluoroscopy performed.
Over a guidewire a 5 French Reuter catheter was formed in the right common
iliac artery and right hypogastric artery. Throughout the entire
procedure, care was exercised to avoid catheter positioning in the distal
abdominal aorta, the site of known aortic dissection planes. With a Reuter
catheter in the hypogastric artery injections were performed in the LAO and
RAO projection. Aneurysm is defined. Vessel overlay strategies utilized.
Subsequently, a guidewire was positioned into the right superior gluteal
artery. The Reuter catheter and sheath were exchanged for a 6 French
Balkan sheath which was positioned in the right hypogastric artery
aneurysm. Through this a 4 French C2 glide catheter was positioned into
the inferior gluteal artery. Selective injections were performed. A
coaxial 3 French renegade catheter was placed. The inferior gluteal artery
origin was embolized with 6 mm-0.18 inch detachable interlock coils. Two-6
mm x 20 cm coils were deployed. The renegade catheter was then positioned
in the proximal superior gluteal artery. The superior gluteal artery was
embolized at its origin with three-8 mm x 20 cm 0.18 inch interlock coils.
Subsequently, the renegade catheter is positioned at the junction of the
superior and inferior gluteal artery into the caudal margin of the aneurysm
sac. This was further embolized with a series of 10 mm, 12 mm, 14 mm-0.18
inch interlock coils. One 10 mm x 30 cm, six-12 mm x 30 cm, and one-14 mm
x 30 cm interlock coils were used to occlude the caudal half of the
aneurysm sac. Through the 6 French Balkan sheath, subsequently two-12 mm
Omplox vascular plugs were deployed in the aneurysm sac proper. The
proximal neck/margin of the aneurysm was subsequently embolized using two-
8mm x 20 cm 0.035 inch Omplox vascular plugs delivered via a 5 French
Reuter catheter. Completion injection demonstrates occlusion of the
aneurysm segment, with minimal penetration likely due to incomplete
thrombosis. No further intervention performed. Sheath removed. Access
site closed using Mynx.
FINDINGS:
3.3 centimeter right hypogastric artery aneurysm partially thrombosed.
Patent right inferior and superior gluteal arteries. Embolization
conducted as above.
As always, thank you for any help/knowledge you can give!
 
Hello,

These new codes for embolizations are still confusing me. What's confusing is how to determine whether the cath placements and diagnostics are ok to code separately. Can someone please help me decide if they are in this report?

PROCEDURES PERFORMED:
Pelvic angiography, cone beam CT angiography and fusion, right hypogastric
artery embolization
IMAGING MODALITY UTILIZED:
Ultrasound and cone beam CT, fluoroscopy
ACCESS SITE:
Right common femoral artery
CATHETER POSITION:
Right internal iliac artery, right superior gluteal artery, right inferior
gluteal artery
CONTRAST UTILIZED: Nonionic contrast utilized.
Under ultrasound guidance, after achieving local
anesthesia with 1 percent lidocaine, the the right common femoral artery
was accessed. A 6 French sheath was inserted.
Cone beam CT was performed. Images were fused with angio dated March 4,
2014. Vessel overlay cone beam CTA fusion with fluoroscopy performed.
Over a guidewire a 5 French Reuter catheter was formed in the right common
iliac artery and right hypogastric artery. Throughout the entire
procedure, care was exercised to avoid catheter positioning in the distal
abdominal aorta, the site of known aortic dissection planes. With a Reuter
catheter in the hypogastric artery injections were performed in the LAO and
RAO projection. Aneurysm is defined. Vessel overlay strategies utilized.
Subsequently, a guidewire was positioned into the right superior gluteal
artery. The Reuter catheter and sheath were exchanged for a 6 French
Balkan sheath which was positioned in the right hypogastric artery
aneurysm. Through this a 4 French C2 glide catheter was positioned into
the inferior gluteal artery. Selective injections were performed. A
coaxial 3 French renegade catheter was placed. The inferior gluteal artery
origin was embolized with 6 mm-0.18 inch detachable interlock coils. Two-6
mm x 20 cm coils were deployed. The renegade catheter was then positioned
in the proximal superior gluteal artery. The superior gluteal artery was
embolized at its origin with three-8 mm x 20 cm 0.18 inch interlock coils.
Subsequently, the renegade catheter is positioned at the junction of the
superior and inferior gluteal artery into the caudal margin of the aneurysm
sac. This was further embolized with a series of 10 mm, 12 mm, 14 mm-0.18
inch interlock coils. One 10 mm x 30 cm, six-12 mm x 30 cm, and one-14 mm
x 30 cm interlock coils were used to occlude the caudal half of the
aneurysm sac. Through the 6 French Balkan sheath, subsequently two-12 mm
Omplox vascular plugs were deployed in the aneurysm sac proper. The
proximal neck/margin of the aneurysm was subsequently embolized using two-
8mm x 20 cm 0.035 inch Omplox vascular plugs delivered via a 5 French
Reuter catheter. Completion injection demonstrates occlusion of the
aneurysm segment, with minimal penetration likely due to incomplete
thrombosis. No further intervention performed. Sheath removed. Access
site closed using Mynx.
FINDINGS:
3.3 centimeter right hypogastric artery aneurysm partially thrombosed.
Patent right inferior and superior gluteal arteries. Embolization
conducted as above.
As always, thank you for any help/knowledge you can give!

Lets pretend for a moment that no aneurysm was found, and no embolization was performed. The question that remains is, why did they do an angiography?

??
 
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