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sma nitroglycerin intra-arterial injectionplease help

  1. #1
    Smile sma nitroglycerin intra-arterial injectionplease help
    Medical Coding Books
    Please help .....
    I am confused about the TPA and the nitroglycerin inj-

    REPORT:
    TECHNIQUE:
    After informed consent was obtained from the patient's wife, the patient was placed supine on the angiography table and prepped and draped in sterile fashion. A 5-French right CFA sheath was already in place. This was upsized to a 6-French sheath to
    allow anesthesia to transduce arterial pressures during the case.

    A C2 catheter was utilized to select the SMA. Contrast injection of the SMA revealed no active arterial extravasation. Based on the imaging features localizing the radiotracer on the nuclear medicine tagged red blood cell study to the probable hepatic
    flexure, and the possibility of a small abnormal tangle of vessels in this region on prior angiography suggesting the possibility of angiodysplasia, the decision was made to select an SMA branch supplying the hepatic flexure using Hi-Flo microcatheter.
    Selective contrast injection of this tertiary branch revealed no active arterial extravasation. Consequently a different more caudal third order SMA branch supplying the hepatic flexure was selected and contrast injection was performed via the
    microcatheter, again revealing no active arterial extravasation from this SMA branch.

    At the request of the transplant service, attention was next turned to performing a provocative study. 100 mg of nitroglycerin was administered into the superior mesenteric artery. The more superior SMA branch supplying the hepatic flexure was again
    selected with a microcatheter, and 100 mg of intra-arterial nitroglycerin was administered via the microcatheter. Again no active arterial extravasation was identified, although the previously mildly spasmed arteries in this region were seen to be of
    more normal and regular caliber after intra-arterial nitroglycerin administration.

    At this point, images and findings were reviewed with the Dr., and the decision was made to proceed with intra-arterial TPA selectively administered to the superior third order SMA branch supplying the hepatic flexure. 2 mg TPA was administered
    intra-arterially via the microcatheter within the superior third order SMA branch supplying the hepatic flexure. Again, no active arterial extravasation was identified, although this vessel had returned to its previous spasmed state. Consequently, the
    decision was made to again retreat this SMA branch vessel with 100 mg intra-arterial nitroglycerin, subsequent to which the artery was again seen to regain a normal caliber. A final global SMA injection was performed, again without evidence of active
    bleed. Despite all of these provocative measures, no active arterial extravasation could be identified and consequently, no target for embolization could be identified.

    The 6-French right CFA sheath was left in place transducing arterial pressures, secured to the skin with 2-0 silk, and dressed in sterile fashion. The patient left the angiography suite in stable condition escorted by anesthesia and the interventional
    radiology resident, and report was personally given to the transplant resident by the interventional radiology resident.

    Thank you in advance,
    AMR
    Last edited by amrcpc; 10-16-2014 at 02:48 PM. Reason: edit physician's name

  2. #2
    Default
    Quote Originally Posted by amrcpc View Post
    Please help .....
    I am confused about the TPA and the nitroglycerin inj-

    REPORT:
    TECHNIQUE:
    After informed consent was obtained from the patient's wife, the patient was placed supine on the angiography table and prepped and draped in sterile fashion. A 5-French right CFA sheath was already in place. This was upsized to a 6-French sheath to
    allow anesthesia to transduce arterial pressures during the case.

    A C2 catheter was utilized to select the SMA. Contrast injection of the SMA revealed no active arterial extravasation. Based on the imaging features localizing the radiotracer on the nuclear medicine tagged red blood cell study to the probable hepatic
    flexure, and the possibility of a small abnormal tangle of vessels in this region on prior angiography suggesting the possibility of angiodysplasia, the decision was made to select an SMA branch supplying the hepatic flexure using Hi-Flo microcatheter.
    Selective contrast injection of this tertiary branch revealed no active arterial extravasation. Consequently a different more caudal third order SMA branch supplying the hepatic flexure was selected and contrast injection was performed via the
    microcatheter, again revealing no active arterial extravasation from this SMA branch.

    At the request of the transplant service, attention was next turned to performing a provocative study. 100 mg of nitroglycerin was administered into the superior mesenteric artery. The more superior SMA branch supplying the hepatic flexure was again
    selected with a microcatheter, and 100 mg of intra-arterial nitroglycerin was administered via the microcatheter. Again no active arterial extravasation was identified, although the previously mildly spasmed arteries in this region were seen to be of
    more normal and regular caliber after intra-arterial nitroglycerin administration.

    At this point, images and findings were reviewed with the Dr., and the decision was made to proceed with intra-arterial TPA selectively administered to the superior third order SMA branch supplying the hepatic flexure. 2 mg TPA was administered
    intra-arterially via the microcatheter within the superior third order SMA branch supplying the hepatic flexure. Again, no active arterial extravasation was identified, although this vessel had returned to its previous spasmed state. Consequently, the
    decision was made to again retreat this SMA branch vessel with 100 mg intra-arterial nitroglycerin, subsequent to which the artery was again seen to regain a normal caliber. A final global SMA injection was performed, again without evidence of active
    bleed. Despite all of these provocative measures, no active arterial extravasation could be identified and consequently, no target for embolization could be identified.

    The 6-French right CFA sheath was left in place transducing arterial pressures, secured to the skin with 2-0 silk, and dressed in sterile fashion. The patient left the angiography suite in stable condition escorted by anesthesia and the interventional
    radiology resident, and report was personally given to the transplant resident by the interventional radiology resident.

    Thank you in advance,
    AMR
    Because the physician was trying to make the colon bleed, it would be considered part of the procedure. No additional codes except for the medication.
    Thanks,
    Jim Pawloski R.T.(CV0, CIRCC

  3. #3
    Default
    Sorry but I am still confused... do not bill 37202 or 37211 only the the cath placements ?

    AMR

  4. #4
    Default
    Quote Originally Posted by amrcpc View Post
    Sorry but I am still confused... do not bill 37202 or 37211 only the the cath placements ?

    AMR
    You should have 36247, 36248,75726, 75774 x 2, 37202, 75896.

    Thanks,
    Jim Pawloski, CIRCC

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