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  1. Default Embolization
    Medical Coding Books


    Are these codes possible for the below report:

    After obtaining informed consent, the patient's left groin was prepped
    and draped in sterile fashion. Using Seldinger technique the left common
    femoral artery was punctured and a 5 Fr. sheath was placed into the
    common femoral artery. Through the sheath, a 4 Fr. Omniflush catheter was
    used to catheterize the aorta. Aortogram was performed with the catheter
    just proximal to the aortic stent graft. Pelvic angiogram was also
    performed with a catheter within the stent graft itself.
    On the pelvic angiogram, there is evidence of redemonstration of a type
    of leak wire lumbar collaterals.
    Similarly, on the abdominal angiogram a subtle leak is seen. However, the
    inferior leak is more impressive.
    A left internal iliac artery injection revealed a collateral branch
    extending into the lumbar artery providing supply to the area of the type
    of leak. This branch was then catheterized and the catheter was then
    placed into the leak site. The site was then coiled with coils. Post
    procedure there was no evidence to suggest a recurrent leak.
    Multiple different catheters and guide wires were used to catheterize a
    lumbar vessel just proximal to the stent graft. This was supplying a
    small leak in the proximal aortic lumen. This was then coiled with as
    single coil. However, the coil extended into the aortic lumen. This coil
    then had to be retrieved and multiple repeat attempts could not gain
    access into the artery. The patient should have a follow-up CT scan to
    see if there is a persistent leak.
    IMPRESSION: Successful embolization of a type of leak in the inferior
    portion of the stent graft.
    Successful catheterization of the vessel supplying the superior leak
    however, this could not be successfully embolized. Repeat scan is
    recommended in two to three months.

  2. Default
    Here's what I get:

    75625 aortogram
    75716 for the "pelvic" angiogram from the aortic graft
    75736 for the true pelvic angiogram from the internal iliac
    37204/75894 for the embolization
    75898 assuming the word "angiogram" was mistakenly omitted after the words "post procedure"

    The selective cath code is a little difficult. You can't code 36200 plus a selective cath because there was only one access. The first embolization was from a branch of the left internal iliac? That seems to be 36246. Then it says this branch extended into the lumbar artery so was the second embolization in the same lumbar artery that came off this branch? If so, it sounds like it might be 3rd order. Otherwise if the lumbar artery was accessed directly off the aorta then it would be 36245-59.

    Diane Huston, CPC,RCC

  3. #3
    I'm on pretty much the same page as Diane...I wasn't 100% on the selective orders because the documentation wasn't real clear. I was thinking that the ipsilateral internal iliac would be a 1st order (36245) from a left groin approach? but I wasn't quite sure if the lumbar came off of this vessel or directly off the aorta? I also wasn't positive if the follow-up (75898) was done...

  4. Default
    Yes, the ipsilateral internal iliac is 1st order but the report goes on to say a branch of that artery was selected so that's where I got 36246. And then I had the same question about the lumbar artery and the post embo angiogram.


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