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Thread: Embolization

  1. #1

    Default Embolization

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    Can we code the embolization code(37204) twice if it done through two different access on two different vessels but at the same session??
    Prabha CPC

  2. #2


    It depends on the circumstances. Were there two separate, unrelated conditions being treated? Or was embolization of two vessels required to treat one condition? I think more information is needed to answer this.

    Diane Huston, CPC,RCC

  3. #3


    Hi Diane,

    Following is the report.

    Procedure: Abdominal aortogram, bilateral extremity arteriogram, and
    embolization of muscular branch of the left superficial femoral artery
    and the right profunda femoris.
    Clinical indication: Massive bleeding from both lower extremities status
    post blunt trauma with open fracture involving the left lower extremity
    and closed fracture involving the right lower extremity.
    Procedure: The patient was under general anesthesia when I was asked to
    come to the Operating Room to performed intraoperative arteriography and
    embolization as indicated.
    Following the above procedures, after waiting approximately 1.5 to 2
    hours, we initiated our procedure. The arterial line was exchanged from
    the right common femoral artery for a #5 French vascular sheath through
    which a #5 French pigtail catheter was placed at the level of the
    abdominal aorta and an abdominal aortogram performed using C-arm.
    Multiple injections were necessary due to the small field of view. No
    active extravasation was identified with particular attention to the
    lumbar arteries as there had been extravasation identified on CT scan
    into the right retroperitoneum. This was not evident on this portion of
    the examination.
    Pelvic arteriography was performed and again no extravasation was
    Following this, the catheter was exchanged for a #5 French RIM catheter
    which was used to selectively catheterize the left common femoral artery.
    Digital subtraction arteriography of the left lower extremity was
    performed. This revealed active extravasation from a muscular branch of
    the distal left superficial femoral artery. After consultation with the
    consulting vascular surgeon, a decision was made to perform embolization.
    This was performed using a #5 French Davis catheter which was used to
    selectively catheterize the bleeding vessel. Via this catheter, a
    Tracker microcatheter was placed and five 2 mm in diameter by 20 mm in
    length microcoils deployed to result in complete cessation of flow
    through the injured artery. Repeat arteriography revealed excellent flow
    down to the level of the foot with no further extravasation identified.
    Following this portion of the procedure, the left common femoral artery
    was punctured with ultrasound guidance with a micropuncture needle.
    Using Seldinger technique, a #5 French vascular sheath was placed.
    Previously performed right lower extremity arteriography through the
    right femoral sheath had revealed active extravasation from branches of
    the right profunda femoris. This was selectively catheterized with a #5
    French RIM catheter. 3 mm, 5 mm, and 8 mm coils with Gelfoam slurry were
    used to completely occlude flow through the profunda femoris. This
    resulted in effective cessation of flow. Good flow was maintained within
    the right common femoral artery with distal flow identified to the level
    of the foot.
    Following the procedure, the sheaths were left in place and placed to
    arterial lines to maintain patency.
    IMPRESSION: Status post embolization of muscular branch of the left
    superficial femoral artery and right profunda femoris as described above.
    Prabha CPC

  4. #4


    This is most definitely two separate embolizations. And remember to code your catheter placements separately from each access.


  5. #5

    Default embolization

    we can code (37204) embolization twice.

    Joseph Amalraj CPC-H
    Last edited by joe_physio09; 05-22-2009 at 02:52 AM.

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