Wiki Y90

AgnieszkaLakritz

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Another one example of Y90 embolization. Dx angiography is giving me hard time.
37243, 36246-50,36247-50? what is the segment 4 ???


Selective Y 90, segment 4.

PROCEDURE:
* Selective angiography of the celiac artery.
* Superselective angiography of the common hepatic artery, right
hepatic artery, right retrograde artery. Superselective angiography of
the left hepatic artery, segment 4 hepatic artery.
* Injection of Y 90 into the segment 4 hepatic artery.
* US and fluoroscopy guided left radial artery access.
* Left radial artery arteriotomy closure with radial band compression
device.

INDICATION:
Metastatic pancreatic cancer.

RADIATION EXPOSURE:
Fluoroscopy Time: 12 minutes
Dose Area Product (DAP): 50 mGy.cm2

ANESTHESIA: Intravenous conscious sedation was administered by
nursing. Continuous hemodynamic and respiratory monitoring was
performed, including the use of pulse oximetry.

SEDATION TIME: 105 minutes

MEDICATIONS: 2 mg Versed, 50 mcg fentanyl, 7000 unit heparin.
PERIOPERATIVE ANTIBIOTICS: 600 mg clindamycin.

TECHNIQUE/FINDINGS:
The risks, benefits and alternatives of the procedure were discussed
with the patient, and informed written consent was obtained. The
patient was brought to the angiography suite, and the left wrist was
prepped and draped in sterile fashion. All elements of maximal sterile
barrier technique were followed including cap and mask, sterile gown,
sterile gloves, large sterile sheet, hand hygiene and 2% chlorhexidine
for cutaneous antisepsis.

Barbeau test was performed, and left radial artery size was measured
on ultrasound to document that there is no contraindication for left
radial access.

Next, left radial artery was accessed under ultrasound and fluoroscopy
guidance. 5 French radial sheath was placed. Radial arterial access
cocktail, mixture of 200 mcg nitroglycerin and 2.5 mg verapamil, was
given through the sheath. Next, 5000 unit IV heparin was given.

Next, the aortic arch was crossed with a combination of 110 cm 5
French Tiger catheter and 035 Rosen wire under fluoroscopy guidance.
The catheter was advanced to abdominal aorta.

Next, celiac artery was selected followed by angiography. Celiac
dividing into left gastric, splenic, and common hepatic.

Next, common hepatic artery was subselected with a combination of
microcatheter microwire in coaxial fashion for by angiography. Common
hepatic artery dividing to proper hepatic artery and GDA.

Right gastric artery come off the proper hepatic artery.

Proper hepatic artery dividing to right and left hepatic artery.

Next, left hepatic artery, and segment 4 hepatic artery was
subselected followed by angiography. There is tumor blush seen with
left hepatic artery, and then segment 4 hepatic artery injection.

Next, the decision was made to proceed with segment 4 Y90 delivery at
the proximal segment 4 hepatic artery location. Approximately mCi
SIRTEX SIR-sphere was deposited at the distal left hepatic artery.
Subsequently, the wire and catheter was removed.
Wires, catheters and sheaths were removed. The left radial artery
hemostasis was achieved with radial band.

The patient tolerated the procedure well and there were no
complications.


The patient tolerated the procedure well without immediate
complication and was transported to Nuclear Medicine for further
imaging.


IMPRESSION:
* 0. 32 GBq/8.54 mCi was delivered, 95.8% of drawn dose, SIRTEX
SIR-sphere was deposited at the proximal segment 4 hepatic artery.
 
Not to sound mean, but Google segment 4 liver. You will find that the liver is divided into 8 segment for liver treatments. I agree with 37243. I see 36247 for the catheter in the segment 4 of the lt hepatic artery, 75726 for visceral angio, 75774 x 2 for the common hepatic injection, and 75774 for the left hepatic injections. I would not code 76377 for the u/s vascular access as the documentation is not appropriate ( no imaging documented). 79445 for the Y-90 infusion. Another question is who is the authorized user as in who decided the dosage for the embolization? there are many codes for that.
HTH,
Jim Pawloski, CIRCC
 
Not to sound mean, but Google segment 4 liver. You will find that the liver is divided into 8 segment for liver treatments. I agree with 37243. I see 36247 for the catheter in the segment 4 of the lt hepatic artery, 75726 for visceral angio, 75774 x 2 for the common hepatic injection, and 75774 for the left hepatic injections. I would not code 76377 for the u/s vascular access as the documentation is not appropriate ( no imaging documented). 79445 for the Y-90 infusion. Another question is who is the authorized user as in who decided the dosage for the embolization? there are many codes for that.
HTH,
Jim Pawloski, CIRCC
This Op report id dictated by one doctor. I code for facility so I will use 36247 and 37243 the rest for 7K codes are up to cath lab
 
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