Wiki emborrhoid procedure help

reneedanielle22

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1. Radiological guidance and interpretation.
2. Ultrasound-guided access of the right common femoral artery.
3. Aortogram with third order subselect of the mesenteric vasculature
4. Embolization of the superior rectal arteries bilaterally.
Consent for aortogram mesenteric angiogram and superior rectal artery embolization is obtained from the patient and/or family members. Advised of risks
regarding infection, bleeding, vascular injury, bowel injury, bowel ischemia and infarct as well as nontarget embolization and recurrence versus benefit of diagnosis with
possible embolization the patient is placed supine on the angiographic
table. Sterile gloves, gowns, drapes, chlorhexidine prep along with hat mask were used throughout
the procedure.
Utilizing sterile technique and ultrasound guidance, the right common femoral artery was accessed with
a micropuncture needle following approximately 10 cc of 2% lidocaine. Ultrasound is initially used to
confirm the patency of the common femoral artery. Utilizing microwire exchange, 5 French
micropuncture dilator was inserted. Next, utilizing J-wire exchange and serial dilatation, a 6 French
Pinnacle destination sheath was advanced into the perirenal aorta.
Aortogram:
An aortogram was performed. Findings: The patient has had prior back surgery. The inferior mesenteric artery is identified.
Next, 5 French Omni select catheter (Sos Omni) is used to subselect the inferior mesenteric artery at which point, a 2.4 microcatheter is advanced with the help of a prograde wire. This microcatheter was eventually advanced into the superior rectal artery beyond the sigmoidal artery where subselective angiography is obtained.
Findings: Prominent vasculature is seen towards the rectum and hemorrhoidal region. At least 7 arteries are identified extending off of the superior rectal artery towards the hemorrhoid.
At this point, at least 5 of these vessels is catheterized with a 2.4 microcatheter at which point subselective embolization is performed with 3 mm and 4 mm coils and a very tiny amount of 700 to 900 µm Embosphere's.
Post embolization angiogram demonstrates excellent radiological results with significant reduction in blood flow seen to the hemorrhoidal region. There is no evidence of nontarget embolization.
Closure:
At this point, all catheter and sheaths are withdrawn with a Celt closure device deployed under ultrasound guidance. Adequate hemostasis is achieved. No immediate complication is noted.

is it coded 37244, 36247, 36245, 75726, 76937 ?
 
I would code 37244, 36247, 36248 x 2, 75726, 75774 x 2. Would not code 76937 as no U/S image was saved. Question back to you, where did you get 36245?
HTH,
Jim
 
37224 - Embolization for arterial bleeding
36247 - 3rd order selective - superior rectal artery
36248 - selective 2nd or 3rd order after the basic - at least 5 of these vessels is catheterized with a 2.4 microcatheter, however they are not named arteries. When they are not named you give them 2 arteries.
75726 - for IMA imaging superior rectal artery
75774 - for two of the 36248 arteries

HTH,
Jim
 
Coding for this would be 36246 for the selection of the superior rectal artery. It is a second order vessel. The procedure is for prominent veins so 37241 Embolization other than hemorrhage is the correct code for the procedure. Unless it states elsewhere that there was an active bleed. Imaging would be included since the hemorrhoids were previously diagnosed. Post embo imaging would also be included.
 
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