Jane5711
Networker
Hi, I'm looking for some advice on how to code the below referenced report. Would you code 36247, 37242 and 75710 or 75736? Any help would be appreciated. Thank you.
SELECTIVE ANGIOGRAM OF THE ILIOLUMBAR BRANCH OF THE RIGHT HYPOGASTRIC ARTERY, AND AORTIC ANEURYSMAL SAC WITH 3RD ORDER CATHETER PLACEMENT
ENDOVASCULAR REPAIR OF TYPE 2 ENDOLEAK VIA RIGHT ILIOLUMBAR BRANCH OF THE HYPOGASTRIC ARTERY WITH PENUMBRA COILING OF PREVIOUSLY REPAIRED ABDOMINAL AORTIC ANEURYSM
INDICATION FOR THE PROCEDURE:
This is an 87-year-old gentleman with history of AAA, and status post EVAR with bifurcating Gore endograft July 2022, patient had follow-up with aortic ultrasound and CTA, and mild 2 mm enlargement in the AAA was noted, but significant type 2 endoleak was noted by CTA, followed by peripheral angiogram, which confirmed significant endoleak wire the iliolumbar branch of the right hypogastric artery, requiring repair.
Pros and cons of procedure were discussed, consent was obtained.
TECHNIQUE:
Arterial access was obtained with ultrasound guidance, micropuncture kit, and and modified Seldinger technique to the right common femoral artery, 6 French sheath was introduced.
Six French 65 cm Cobra catheter was used for selective right hypogastric angiogram, and was positioned to the proximal right hypogastric artery.
Proximal iliolumbar branch of the hypogastric artery was selectively engaged with 260 cm 0.035 angled Glidewire, followed by position of the 4 French 140 cm glide catheter to the proximal iliolumbar branch, and selective angiogram, followed by advancement of the 300 cm V 18 wire through the iliolumbar branch to the aneurysmal sac, and followed by position of 0.018 140 cm microcatheter to the aneurysmal sac, used for endovascular repair with penumbra coils.
Blood loss was negligible.
Blood samples were taken for ACT.
IV heparin was used for therapeutic ACT during the procedure, ACT was in excess of 250.
Local anesthesia was with 2% lidocaine 10 cc to the right groin.
Procedure was performed under anesthesia, provided by Department of anesthesia with ___and CRNA ____ please see separate report
Procedure time was 84 minutes, there were no immediate complications.
Contrast used–30 cc.
6 French Angio-Seal closure device was successfully deployed to the right common femoral artery upon completion of the procedure.
HEMODYNAMICS:
Aortic pressure was 140/70 mmHg.
SELECTIVE RIGHT HYPOGASTRIC, AND THEN ILIOLUMBAR BRANCH ANGIOGRAM:
While hypogastric angiogram was obtained on previous angiogram October 2023, selective iliolumbar angiogram and opacification of the aneurysmal sac was performed today.
As described above over the Glidewire we placed 4 French angled glide catheter to the proximal right iliolumbar branch, and performed angiogram in LAO caudal projection.
It showed about 2-2.5 mm branch with significant retrograde flow-endoleak to the aneurysmal sac, which showed signs of incomplete thrombosis.
There was no evidence of any extravasation beyond the AAA. There were very small tributaries via the left lumbar artery and IMA.
ENDOVASCULAR REPAIR OF TYPE 2 ENDOLEAK VIA RIGHT ILIOLUMBAR BRANCH OF THE HYPOGASTRIC ARTERY WITH PENUMBRA COILING:
Once selective angiogram confirmed significant endoleak we proceeded with repair, as described above we advanced 300 cm V 18 wire through the glide catheter and to the aneurysmal sac, the glide catheter was removed, and then we placed 140 cm 0.018 catheter to the aneurysmal sac, respectively V18 wire was removed, then we placed sequentially to gradually feel the aneurysmal sac, and right iliolumbar branch 18 penumbra coils: 40 by 60 standard, 36 x 60 standard, 32 x 60 standard, 28 x 60 standard, 24 x 60 standard, 20 x 60 by 2 standard, 18 x 60 standard, 16 x 60 standard, 18 x 50 soft, 12 x 60 standard, 14 x 60 standard, 10 x 35 standard, 8 x 40 standard, 8 x 25 standard, and then for the contributing vessel we used packing 60 cm coils x2, and additional 45 cm packing coil.
Final angiogram through the 0.018 catheter positioned through the proximal right iliolumbar branch, showed excellent result with occlusion of the vessel, and no evidence of flow to the aneurysmal sac.
0.018 catheter and 6 French guiding Cobra catheter were removed, and Angio-Seal deployed to the right common femoral artery.
Patient tolerated procedure well without any complications.
CONCLUSIONS:
1. Abdominal aortic aneurysm with status post EVAR with bifurcating Gore endograft July 2023, significant type 2 endoleak via right iliolumbar branch of the hypogastric artery.
2. Successful endovascular embolization of the residual aneurysmal sac, and tribute right iliolumbar branch of the hypogastric artery with 18 penumbra coils.
3. Patient will continue with his current medical treatment unchanged, we will plan aortic ultrasound postprocedure. CTA as needed.
SELECTIVE ANGIOGRAM OF THE ILIOLUMBAR BRANCH OF THE RIGHT HYPOGASTRIC ARTERY, AND AORTIC ANEURYSMAL SAC WITH 3RD ORDER CATHETER PLACEMENT
ENDOVASCULAR REPAIR OF TYPE 2 ENDOLEAK VIA RIGHT ILIOLUMBAR BRANCH OF THE HYPOGASTRIC ARTERY WITH PENUMBRA COILING OF PREVIOUSLY REPAIRED ABDOMINAL AORTIC ANEURYSM
INDICATION FOR THE PROCEDURE:
This is an 87-year-old gentleman with history of AAA, and status post EVAR with bifurcating Gore endograft July 2022, patient had follow-up with aortic ultrasound and CTA, and mild 2 mm enlargement in the AAA was noted, but significant type 2 endoleak was noted by CTA, followed by peripheral angiogram, which confirmed significant endoleak wire the iliolumbar branch of the right hypogastric artery, requiring repair.
Pros and cons of procedure were discussed, consent was obtained.
TECHNIQUE:
Arterial access was obtained with ultrasound guidance, micropuncture kit, and and modified Seldinger technique to the right common femoral artery, 6 French sheath was introduced.
Six French 65 cm Cobra catheter was used for selective right hypogastric angiogram, and was positioned to the proximal right hypogastric artery.
Proximal iliolumbar branch of the hypogastric artery was selectively engaged with 260 cm 0.035 angled Glidewire, followed by position of the 4 French 140 cm glide catheter to the proximal iliolumbar branch, and selective angiogram, followed by advancement of the 300 cm V 18 wire through the iliolumbar branch to the aneurysmal sac, and followed by position of 0.018 140 cm microcatheter to the aneurysmal sac, used for endovascular repair with penumbra coils.
Blood loss was negligible.
Blood samples were taken for ACT.
IV heparin was used for therapeutic ACT during the procedure, ACT was in excess of 250.
Local anesthesia was with 2% lidocaine 10 cc to the right groin.
Procedure was performed under anesthesia, provided by Department of anesthesia with ___and CRNA ____ please see separate report
Procedure time was 84 minutes, there were no immediate complications.
Contrast used–30 cc.
6 French Angio-Seal closure device was successfully deployed to the right common femoral artery upon completion of the procedure.
HEMODYNAMICS:
Aortic pressure was 140/70 mmHg.
SELECTIVE RIGHT HYPOGASTRIC, AND THEN ILIOLUMBAR BRANCH ANGIOGRAM:
While hypogastric angiogram was obtained on previous angiogram October 2023, selective iliolumbar angiogram and opacification of the aneurysmal sac was performed today.
As described above over the Glidewire we placed 4 French angled glide catheter to the proximal right iliolumbar branch, and performed angiogram in LAO caudal projection.
It showed about 2-2.5 mm branch with significant retrograde flow-endoleak to the aneurysmal sac, which showed signs of incomplete thrombosis.
There was no evidence of any extravasation beyond the AAA. There were very small tributaries via the left lumbar artery and IMA.
ENDOVASCULAR REPAIR OF TYPE 2 ENDOLEAK VIA RIGHT ILIOLUMBAR BRANCH OF THE HYPOGASTRIC ARTERY WITH PENUMBRA COILING:
Once selective angiogram confirmed significant endoleak we proceeded with repair, as described above we advanced 300 cm V 18 wire through the glide catheter and to the aneurysmal sac, the glide catheter was removed, and then we placed 140 cm 0.018 catheter to the aneurysmal sac, respectively V18 wire was removed, then we placed sequentially to gradually feel the aneurysmal sac, and right iliolumbar branch 18 penumbra coils: 40 by 60 standard, 36 x 60 standard, 32 x 60 standard, 28 x 60 standard, 24 x 60 standard, 20 x 60 by 2 standard, 18 x 60 standard, 16 x 60 standard, 18 x 50 soft, 12 x 60 standard, 14 x 60 standard, 10 x 35 standard, 8 x 40 standard, 8 x 25 standard, and then for the contributing vessel we used packing 60 cm coils x2, and additional 45 cm packing coil.
Final angiogram through the 0.018 catheter positioned through the proximal right iliolumbar branch, showed excellent result with occlusion of the vessel, and no evidence of flow to the aneurysmal sac.
0.018 catheter and 6 French guiding Cobra catheter were removed, and Angio-Seal deployed to the right common femoral artery.
Patient tolerated procedure well without any complications.
CONCLUSIONS:
1. Abdominal aortic aneurysm with status post EVAR with bifurcating Gore endograft July 2023, significant type 2 endoleak via right iliolumbar branch of the hypogastric artery.
2. Successful endovascular embolization of the residual aneurysmal sac, and tribute right iliolumbar branch of the hypogastric artery with 18 penumbra coils.
3. Patient will continue with his current medical treatment unchanged, we will plan aortic ultrasound postprocedure. CTA as needed.
Jane