How would this be coded? new to IR, have never seen one of these
PROCEDURE:
Spinal - lumbar vertebral angiogram with vertebral artery embolization.
HISTORY:
Renal cell metastasis to L4. Lytic destruction. Planned neurosurgical corpectomy with reconstruction. Previous surgical embolization requested to control bleeding.
PROCEDURE DESCRIPTION:
The right common femoral artery was seen by ultrasound and found to be patent and compressible. The artery was entered with a 21 gauge needle using ultrasound as guidance. A permanent record of the
image showing needle placement was documented. A 4-French vascular dilator was placed and a Bentson guidewire was advanced to the abdominal aorta. A 5-French vascular sheath was placed at the
access site.
5-French Nicholson catheter was advanced to the thoracic aorta. The catheter was reformed at the arch and brought to the L3-L4 level. Selective arteriography was performed of the lumbar L4
arteries, right and left ( first order divisions). See findings.
Nicholson catheter was selectively placed into the left L4 lumbar artery. A Progreat microcatheter was advanced through the base catheter. Empiric Gelfoam embolization was performed of a lateral
lateral branch (second order) , not involved with tumor arterial supply up. The temporary embolic agent of Gelfoam was used to protect these arteries were that will likely recanalized within 24
hours.
Attention was directed to the flow to the tumor involving the vertebral body of L4. Particle embolization was then completed of the first order branch using permanent PVA particles of 150 - 300
micron diameter , delivered during intermittent fluoroscopy. Complete arterial stasis was obtained of the dominant feeding arteries to the left side of the L4 vertebral body. Additional Gelfoam was
placed into the major trunk of the L4 left vertebral artery. No significant reflux occurred. Arterial stasis was obtained of the left L4 vertebral artery.
Attention was directed to the right L4 vertebral artery (first order). Angiography shows some cross fill from right to left side in and following that tumor. The microcatheter was then again
advanced through the base catheter placed in the lateral branch (second order) of the right vertebral artery. Gelfoam embolization was performed to protect this artery. The catheter was then placed
towards central artery with additional branches extending into the tumor in the right side of the vertebral body. Permanent particle embolization was completed of the first order division artery
with the PVA particles. Arterial stasis was obtained.
Attention was directed to additional arterial supply. The catheter was used to interrogate selectively the L3 vertebral arteries, left and right. No arterial supply was seen towards L4.
Catheter was selectively placed into the L5 artery which was a branch of the middle sacral artery. No supply was seen extending superior from the middle sacral - L5 vertebral arteries.
Angiography of the right common femoral and external iliac artery was performed prior to closure device placement. Catheter wires removed. Vascular sheath at the right common femoral artery was
removed during application Star closure. A closure was uneventful. Hemostasis was obtained with a Star close twice and manual compression.
I came up with 37243, 37243-59,36245-50,36246,36246-59,75710,G0269 (closure device)
thanks
PROCEDURE:
Spinal - lumbar vertebral angiogram with vertebral artery embolization.
HISTORY:
Renal cell metastasis to L4. Lytic destruction. Planned neurosurgical corpectomy with reconstruction. Previous surgical embolization requested to control bleeding.
PROCEDURE DESCRIPTION:
The right common femoral artery was seen by ultrasound and found to be patent and compressible. The artery was entered with a 21 gauge needle using ultrasound as guidance. A permanent record of the
image showing needle placement was documented. A 4-French vascular dilator was placed and a Bentson guidewire was advanced to the abdominal aorta. A 5-French vascular sheath was placed at the
access site.
5-French Nicholson catheter was advanced to the thoracic aorta. The catheter was reformed at the arch and brought to the L3-L4 level. Selective arteriography was performed of the lumbar L4
arteries, right and left ( first order divisions). See findings.
Nicholson catheter was selectively placed into the left L4 lumbar artery. A Progreat microcatheter was advanced through the base catheter. Empiric Gelfoam embolization was performed of a lateral
lateral branch (second order) , not involved with tumor arterial supply up. The temporary embolic agent of Gelfoam was used to protect these arteries were that will likely recanalized within 24
hours.
Attention was directed to the flow to the tumor involving the vertebral body of L4. Particle embolization was then completed of the first order branch using permanent PVA particles of 150 - 300
micron diameter , delivered during intermittent fluoroscopy. Complete arterial stasis was obtained of the dominant feeding arteries to the left side of the L4 vertebral body. Additional Gelfoam was
placed into the major trunk of the L4 left vertebral artery. No significant reflux occurred. Arterial stasis was obtained of the left L4 vertebral artery.
Attention was directed to the right L4 vertebral artery (first order). Angiography shows some cross fill from right to left side in and following that tumor. The microcatheter was then again
advanced through the base catheter placed in the lateral branch (second order) of the right vertebral artery. Gelfoam embolization was performed to protect this artery. The catheter was then placed
towards central artery with additional branches extending into the tumor in the right side of the vertebral body. Permanent particle embolization was completed of the first order division artery
with the PVA particles. Arterial stasis was obtained.
Attention was directed to additional arterial supply. The catheter was used to interrogate selectively the L3 vertebral arteries, left and right. No arterial supply was seen towards L4.
Catheter was selectively placed into the L5 artery which was a branch of the middle sacral artery. No supply was seen extending superior from the middle sacral - L5 vertebral arteries.
Angiography of the right common femoral and external iliac artery was performed prior to closure device placement. Catheter wires removed. Vascular sheath at the right common femoral artery was
removed during application Star closure. A closure was uneventful. Hemostasis was obtained with a Star close twice and manual compression.
I came up with 37243, 37243-59,36245-50,36246,36246-59,75710,G0269 (closure device)
thanks