Wiki RT/LT Hypogastric Artery Angiogram

carelitz

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Another one that is totally new to me. Any help is appreciated. I am thinking the hypogastric artery just needs a selective cath placement code and is included in the 75716. Is that correct?

Common iliac branches into external iliac and “internal iliac” (formerly known as the hypogastric artery)

i have so far:
75716 26 (bilateral lower extremity angiogram)
75625 26 (abdominal angiogram)
36246 5059 (second order cath placement into RT/LT internal iliac)

PROCEDURE PERFORMED:

1. Abdominal aortogram and bilateral lower extremity angiogram.
2. Selective right and left hypogastric artery angiogram.
3. Second order catheter placement to:
a. Right hypogastric artery.
b. Right superficial femoral artery/second order.
c. Left hypogastric artery.

INDICATIONS FOR PROCEDURE: This is a gentleman with
longstanding history of hypertension which is severe and difficult to
control, dyslipidemia, obesity, who developed symptoms of buttock
claudication and erectile dysfunction, and with significant clinical
suspicion for peripheral vascular disease, specifically hypogastric
disease, peripheral angiogram was recommended. Pros and cons of procedure
were discussed, consent was obtained.

TECHNIQUE: Considering that symptoms were right-sided, the left access
was selected.

Left common femoral artery access was obtained with micropuncture kit and
modified Seldinger technique and 5-French sheath was introduced.

A 5-French Omni Flush catheter was used for abdominal aortogram and was
positioned in the descending aorta above origin of renal arteries and
power injection of 25 mL of contrast was obtained in AP projection.

Bilateral iliac angiogram was obtained through the same Omni Flush
catheter positioned to the distal aortic valve aortic bifurcation and AP
projection with power injection of 20 mL of contrast.

With a right lower extremity angiogram, the Omni Flush catheter was
advanced across the aortic bifurcation to the proximal right superficial
femoral artery and angiogram obtained, then with the support of Versacore
wire, a 5-French 65 cm glide catheter was positioned to the proximal right
hypogastric artery for selective right hypogastric angiogram.


Operative Report/Procedure Note
Then, the Omni Flush catheter was positioned to the right common iliac
artery and then tip navigated to the left common iliac artery and then
tipped navigated to the proximal left hypogastric artery for selective
angiogram.

Left lower extremity angiogram obtained through the 5-French sheath in the
left femoral artery.

HEMODYNAMICS:

1. Arterial pressure was 170/90 mmHg.
2. The moderate sedation was provided with IV Versed and fentaNYL 1 mg
and 50 mcg respectively. Local anesthesia with 2 percent lidocaine
10 mL to the left groin, the blood loss was negligible.
3. There were no immediate complications.

ANGIOGRAM FINDINGS:

ABDOMINAL AORTOGRAM:

1. Normal size abdominal aorta without evidence of aneurysm or
dissection without evidence of any significant atherosclerotic
plaque or obstruction.
2. Left renal artery is a large vessel free of any stenotic disease.
3. Right renal artery is a large vessel without evidence of any
significant stenotic disease.

BILATERAL ILIAC ANGIOGRAM:

RIGHT ILIAC ARTERY;

1. Common iliac artery is a large vessel without stenosis.
2. External iliac artery is a large vessel without stenosis.
3. Hypogastric artery, selective angiogram was performed with the
placement of 5-French glide catheter to the proximal portion of the
vessel, this is a large vessel, which is fully patent, no evidence
of stenosis, including to the distal branches of the vessel.

LEFT ILIAC ARTERY:

1. Common iliac artery is large vessel, no stenosis.
2. External iliac artery is large vessel, no stenosis.
3. Hypogastric artery is selectively engaged with a 5-French Omni Flush
catheter to the proximal portion, large vessel, no stenosis,
including no branch stenosis.

RIGHT LOWER EXTREMITY ANGIOGRAM:

1. Common femoral artery is large vessel, no stenosis.
2. Deep femoral artery is large vessel, no stenosis.
3. Superficial femoral artery is a large vessel with minimal luminal
irregularities, no significant stenosis.
4. Popliteal artery is large vessel, no stenosis.
5. Anterior tibial artery medium-sized vessel, no stenosis.
6. Tibioperoneal trunk medium-sized vessel, no stenosis.
7. Posterior tibial artery medium-sized vessel, no stenosis.
8. Peroneal artery medium-sized vessel, no stenosis.

LEFT LOWER EXTREMITY ANGIOGRAM:

1. Common femoral artery is a large vessel, no stenosis.
2. Deep femoral artery is a large vessel, no stenosis.
3. Superficial femoral artery is large vessel, no stenosis.
4. Popliteal artery is large vessel, minimal luminal irregularities, no
significant stenosis.
5. Anterior tibial artery medium-sized vessel, no stenosis.
6. Tibioperoneal trunk medium-sized vessel, no stenosis.
7. Posterior tibial artery medium-sized vessel, no stenosis.
8. Peroneal artery medium-sized vessel, no stenosis.
 

Attachments

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Last edited:
Since the internal iliacs were selected, I would code for them. So how I would code is 36246-LT, 36245-RT, 75736-50, 75625, 75716, 99152.

HTH,
Jim Pawloski, CIRCC
 
Since the internal iliacs were selected, I would code for them. So how I would code is 36246-LT, 36245-RT, 75736-50, 75625, 75716, 99152.

HTH,
Jim Pawloski, CIRCC

One more question. Why is it one 1st order (RT) and one 2nd order (LT) cath placement instead of 36246 50 for selecting the RT/LT internal iliacs?
 
Access is on the right side (femoral artery). The first branch that you come to is the right internal iliac. That would be a first order selective.
Again, from the right side, the catheter goes up to the aorta, and the left common iliac is selected. That is 36245, then the left internal iliac is selected. 36245 goes away, and 36246 is coded.

HTH,
Jim
 
Access is on the right side (femoral artery). The first branch that you come to is the right internal iliac. That would be a first order selective.
Again, from the right side, the catheter goes up to the aorta, and the left common iliac is selected. That is 36245, then the left internal iliac is selected. 36245 goes away, and 36246 is coded.

HTH,
Jim

Got it, thanks so much for the explanation!!
 
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