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  1. Default Embolization
    Medical Coding Books
    Can we code this procedure with


    Using Seldinger technique, the right
    common femoral artery was punctured and a 5 French sheath was placed into
    the common femoral artery. Through the sheath, 5 French Cobra catheter
    was used to catheterize the hepatic artery. Hepatic angiogram was
    The angiogram revealed patent celiac axis, patent hepatic gastroduodenal
    and splenic artery. The patient's left gastric artery is hypertrophied.
    The portal vein is patent.
    There is evidence of varices noted in the level of the GE junction.
    On the hepatic angiogram, two hypervascular masses are noted. One is in
    the right lobe, one is in the left lobe.
    The third lesion that is seen on CT scan is not visualized on the
    Superselective catheterization of the right hepatic artery was performed
    with a renegade catheter. The catheter was placed proximal to the tumor
    and embolization was performed with particles, ranging from 300 to 500
    microns. Stasis was achieved.
    The left hepatic artery is catheterized. However, adequate purchase could
    not be made with a catheter into the artery supplying the tumor.
    An accessory artery was then catheterized that also supplied the tumor.
    But the accessory artery also supplied what appeared to be the caudate
    lobe. The artery of the caudate lobe was first accessed and embolized
    with coils to prevent any flow into the caudate lobe. Post-protection of
    the caudate lobe, embolization was carried out of the left hepatic
    lesion. Stasis was achieved in artery supplying the left hepatic lesion.
    Angiogram was performed which revealed no evidence of flow to the
    previously demonstrated tumors. There is again nonvisualization of the
    third lesion that was seen on the CT scan.
    IMPRESSION: Visualization of only two of the tumors seen on the CT scan.
    The third tumor is not visualized.
    Successful embolization of both tumors with particles ranging from 300
    to 505 microns.
    Prabha CPC

  2. Default
    I don't see angiograms for the Rt and Lt hepatic arteries. I do think they were done, I just don't see them documented.

    Not sure where that accessory artery is coming from. It may be another 36248 if you had more info. Agree with your other codes.

    Diane Huston, CPC,RCC

  3. #3
    true, they didn't mention the angio's done in the super selected arteries. I'm so used to my physicians documentation...they always mention that
    I do see a third order 36247(right hepatic) and an additional 3rd order (left hepatic) 36248. The accessory is most likely another 3rd order but they should mention which accessory artery it is in order to code it.

  4. Default
    Thanks for your valuable inputs
    Prabha CPC

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