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Thread: embolization - Two arteries in one vascular

  1. #1

    Default embolization - Two arteries in one vascular

    AAPC: Back to School
    Two arteries in one vascular family is embolized
    How many embolization we have to code 1 or 2.

    Study: Superior mesenteric arteriogram and superselective embolization of
    branches of the right colic and middle colic arteries.
    Clinical indication: Recurrent severe lower-gastrointestinal bleeding
    from the hepatic flexure.
    Procedure: After obtaining informed consent, the patient was placed in
    the supine position and the right groin prepped and draped in sterile
    fashion. The skin was anesthetized with 1% lidocaine. A micropuncture
    needle was used to access the right common femoral artery. Using
    Seldinger technique a 5 French vascular sheath was placed. Via this
    sheath a 5 French cobra catheter was used to selectively catheterize the
    superior mesenteric artery.
    Superior mesenteric arteriography revealed hypervascularity involving the
    hepatic flexure. Via the cobra catheter, a Tracker micro-catheter was
    advanced into the branch of the right colic artery supplying the hepatic
    flexure. Hypervascularity without active extravasation was identified.
    CO2 was injected in an attempt to better elucidate extravasation without
    success. Given the firm confirmation of bleeding from the hepatic flexure
    on endoscopy, it seemed prudent to perform coil embolization with three 2
    mm in diameter x 2 cm in length micro-coils. This resulted in sluggish
    flow through this artery.
    Following the right colic artery embolization, the middle colic artery
    was selectively catheterized and the branch supplying the hepatic flexure
    also catheterized. Again, 2 mm in diameter micro-coils were deployed x
    two into this branch. This also resulted in sluggish flow to the hepatic
    flexure branch.
    Following the procedure, the catheter and sheaths were removed from the
    right groin and pressure applied for 10 minutes. There is no
    postprocedural hematoma, no change in distal vascular examination. The
    patient tolerated the procedure well and was transported to her room in
    stable condition.
    Findings were discussed with *******, consulting gastrointestinal
    surgeon 3/27/09 at approximately 1:30 pm.
    IMPRESSION: Status-post superselective embolization of branches of the
    right colic and middle colic artery as described above.

  2. #2


    It appears to be one operative site. Often times more than one vessel needs to be embolized to stop GI bleed but you only code the embo once. It had been an open procedure, how many openings would have been needed to do this procedure? That's how to determine whether to code multiple embolizations.

    Diane Huston, CPC,RCC

  3. #3



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