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embolization - Can any one confirm my codes

  1. Default embolization - Can any one confirm my codes
    Exam Training Packages
    Hello:
    Can any one confirm my codes
    Lumbar Arteries
    36245
    36245-59
    75705
    75705-59
    Aortogram
    75630

    Internal iliacs
    36247
    75736
    75774
    36245-59
    75736-59

    embolization:
    37204
    75894
    75898

    Aortogram, pelvic arteriogram and embolization:
    Clinical history: Trauma.
    On an emergent basis, the patient was brought to the Interventional
    Radiology Department. The patient's right groin was prepped and draped
    in the usual sterile fashion. Several attempts at identifying the right
    common femoral artery under ultrasound were unsuccessful. The patient's
    left groin was, therefore, prepped and draped in the usual sterile
    manner. The patient's left common femoral artery was punctured and a
    vascular sheath was placed. Over a guide wire, a catheter was advanced
    into the abdominal aorta and contrast injection was performed revealing
    the abdominal aorta to be patent and normal in caliber. The left common
    iliac, external iliac and internal iliac artery are visualized without
    definite evidence of extravasation. Diminished flow within the right
    common and external iliac artery was visualized.
    Selective catheterization of several lumbar arteries was achieved.
    Contrast injection was performed revealing no definite evidence of active
    extravasation from any of the visualized right-sided lumbar arteries.
    The catheter was exchanged and selective catheterization of the right
    common iliac and subsequently internal iliac artery
    was achieved.
    Contrast injection was performed revealing abrupt termination of the
    anterior and posterior divisions of the internal iliac artery. Several
    attempts at advancing a guide wire into the distal portions were
    unsuccessful. Given the appearance on the patient's prior CT scan and
    the abrupt termination of the vessels, avulsion of the vessels was
    suspected and, therefore, a Gelfoam slurry embolization of the internal
    iliac artery on the right was performed.
    The catheter was withdrawn and contrast injection repeated revealing no
    evidence of active extravasation. A branch vessel originating from the
    internal iliac artery leading into the region of the right flank was
    identified which also demonstrated abrupt termination but led to the site
    of the patient's large right flank hematoma. Subselective
    catheterization of this vessel with a microcatheter was achieved.
    Contrast injection was performed revealing this to be the source of the
    large flank hematoma. Coil embolization of this vessel with 2 and 3 mm
    coils was achieved.
    The catheter was then repositioned into the right external iliac artery
    and contrast injection was performed revealing abrupt termination of the
    external iliac artery at the level of the femoral head. The common
    femoral artery was not visualized.
    The catheter was withdrawn and selective catheterization of the left
    internal iliac artery was achieved
    . Contrast injection revealed no
    evidence of extravasation from the left side.
    The catheter was removed and the vascular sheath was left in place and
    secured to the skin.
    The patient tolerated the procedure without evidence of immediate
    complication.

  2. #2
    Default
    I would ask for clarification on how many lumbar arteries were selected and also what the name of the branch was that was "subselected" off of the internal iliac on the right. The right internal would be a 2nd order from the left groin puncture, was the additional vessel another 2nd order? 3rd order?

  3. Default
    Here's what I got from it:

    For the lumbar arteries I would only code 36245 x2 and 75705 x2 unless you can get info on the exact number and an addendum would be good to specifically identify them in case an appeal is needed.

    75630 aortogram and runoff

    Rt Int Iliac branch 36247
    Rt Ext Iliac 36248
    Lt Int Iliac 36245

    75736 x2 for the interal iliac angiograms
    75774 for the Rt Int Iliac branch angiogram
    75710 or 75774 for the Rt Ext Iliac angiogram (not sure if 75710 is bundled and don't have access to cci edit)

    37204
    75894
    75898

    Diane Huston, CPC,RCC

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