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celiac stent placement

  1. Default celiac stent placement
    Exam Training Packages
    Can we code the below procedure with

    37205
    36245
    75960-26
    75726-26
    75625-26

    Procedure. Aortogram. Celiac arteriogram. Celiac angioplasty
    and stent placement.
    Procedure.
    Informed consent was obtained. The patient was prepped and draped
    appropriately and after infiltration with local anesthesia the
    left axillary artery was punctured with a micropuncture set and a
    long 6-French sheath introduced. Through this an Omniflush
    catheter was manipulated into the descending aorta and the sheath
    further advanced. The Omni flush catheter was then positioned
    just above the celiac axis and contrast injected with filming in
    the lateral projection.

    Findings.
    Aortogram.
    The aortogram shows two superior mesenteric artery stents which do
    not overlap. The trailing end of the proximal stent is not in the
    true aortic lumen. There is extensive calcification in the region
    of the celiac axis and extending to 1 cm above it. There is a
    large saucerized plaque across the origin of the celiac artery.
    The celiac artery is not seen but some contrast does fill to the
    celiac branches. No contrast enters the superior mesenteric
    artery. The stents extend over a distance of 5 cm.

    Celiac arteriogram.
    The hepatic and splenic arteries fill but there is a 95% stenosis
    in the right hepatic artery. The gastroduodenal is enlarged but
    is not in continuity with the inferior pancreaticoduodenal artery.
    The distal branch of the gastroduodenal artery fills some of the
    duodenum and there is reconstitution of the ileocolic artery and
    several mesenteric vessels. The amount of filling is poor. There
    has been a previous bowel resection. Also filling is an isolated
    middle colic artery which fills the left colic down to about the
    sigmoid. The inferior mesenteric artery does not reconstitute.

    Procedure.
    The Omni flush catheter was exchanged for a Berenstein catheter
    and a stiff Terumo wire used to probe the superior mesenteric
    artery but this vessel could not be entered. The catheter was
    then pulled back and the celiac artery entered followed by the
    Berenstein catheter. An exchange is made over a Rosen wire for a
    7 mm Palmaz Genesis stent 29 mm in length which was positioned
    across the ostial stenosis with its trailing end into the aorta.
    A slight waist where the stent passed through the aortic wall
    calcium could not be completely eliminated but a 6-mm diameter was
    achieved. A celiac arteriogram was performed before the stent was
    placed.

    Contrast injection after the procedure demonstrated good flow
    through the celiac trunk via the stent. The celiac pressure which
    previously had been 23 mm systolic now equalized with the aortic
    pressure to demonstrate that the 110mm gradient had been removed.

    Impression.
    Status post SMA stent placement with occlusion of the superior
    mesenteric artery. The mesenteric circulation is extensively
    compromised with no inferior pancreaticoduodenal and no connection
    save for via collaterals with the middle and left colic artery.
    The IMA does not fill.
    7 mm stent placement in a subtotal occlusion of the celiac trunk.
    Prabha CPC

  2. Default
    That is correct though the visceral angiogram will need a 59 modifier due to the stent placement 75726-26-59.

  3. #3
    Location
    Birmingham, Alabama
    Posts
    889
    Default
    Quote Originally Posted by prabha View Post
    Can we code the below procedure with

    37205
    36245
    75960-26
    75726-26
    75625-26

    Procedure. Aortogram. Celiac arteriogram. Celiac angioplasty
    and stent placement.
    Procedure.
    Informed consent was obtained. The patient was prepped and draped
    appropriately and after infiltration with local anesthesia the
    left axillary artery was punctured with a micropuncture set and a
    long 6-French sheath introduced. Through this an Omniflush
    catheter was manipulated into the descending aorta and the sheath
    further advanced. The Omni flush catheter was then positioned
    just above the celiac axis and contrast injected with filming in
    the lateral projection.

    Findings.
    Aortogram.
    The aortogram shows two superior mesenteric artery stents which do
    not overlap. The trailing end of the proximal stent is not in the
    true aortic lumen. There is extensive calcification in the region
    of the celiac axis and extending to 1 cm above it. There is a
    large saucerized plaque across the origin of the celiac artery.
    The celiac artery is not seen but some contrast does fill to the
    celiac branches. No contrast enters the superior mesenteric
    artery. The stents extend over a distance of 5 cm.

    Celiac arteriogram.
    The hepatic and splenic arteries fill but there is a 95% stenosis
    in the right hepatic artery. The gastroduodenal is enlarged but
    is not in continuity with the inferior pancreaticoduodenal artery.
    The distal branch of the gastroduodenal artery fills some of the
    duodenum and there is reconstitution of the ileocolic artery and
    several mesenteric vessels. The amount of filling is poor. There
    has been a previous bowel resection. Also filling is an isolated
    middle colic artery which fills the left colic down to about the
    sigmoid. The inferior mesenteric artery does not reconstitute.

    Procedure.
    The Omni flush catheter was exchanged for a Berenstein catheter
    and a stiff Terumo wire used to probe the superior mesenteric
    artery but this vessel could not be entered. The catheter was
    then pulled back and the celiac artery entered followed by the
    Berenstein catheter. An exchange is made over a Rosen wire for a
    7 mm Palmaz Genesis stent 29 mm in length which was positioned
    across the ostial stenosis with its trailing end into the aorta.
    A slight waist where the stent passed through the aortic wall
    calcium could not be completely eliminated but a 6-mm diameter was
    achieved. A celiac arteriogram was performed before the stent was
    placed.

    Contrast injection after the procedure demonstrated good flow
    through the celiac trunk via the stent. The celiac pressure which
    previously had been 23 mm systolic now equalized with the aortic
    pressure to demonstrate that the 110mm gradient had been removed.

    Impression.
    Status post SMA stent placement with occlusion of the superior
    mesenteric artery. The mesenteric circulation is extensively
    compromised with no inferior pancreaticoduodenal and no connection
    save for via collaterals with the middle and left colic artery.
    The IMA does not fill.
    7 mm stent placement in a subtotal occlusion of the celiac trunk.
    The Omni flush catheter was then positioned
    just above the celiac axis and contrast injected with filming in
    the lateral projection.

    This implies that the celiac was not selected for the initial visceral angiography therefor this is an abdominal aortogram only. A celiac arteriogram was performed before the stent was placed. There is no interpretation for this procedure.

    The post stent images are for follow up only and should not be considered a diagnostic visceral angiography IMO.

    Under the impression the physician states the stent was placed in the SMA but the procedural documentation is for the celiac. This does not change the code but needs to be clairfied for document integrity.

    So, I would code
    37205/75960 (26)
    36245
    75625 (26)

    HTH
    Danny L. Peoples
    CIRCC,CPC

  4. Default
    The Interpretation is before the procedure under the heading Celiac Arteriogram.

  5. #5
    Location
    Birmingham, Alabama
    Posts
    889
    Default
    Quote Originally Posted by mikereyland View Post
    The Interpretation is before the procedure under the heading Celiac Arteriogram.
    The celiac had not yet been selected. The code 75726 requires selection of the artery.

    Danny L. Peoples
    CIRCC,CPC

  6. #6
    Default
    Quote Originally Posted by dpeoples View Post
    The celiac had not yet been selected. The code 75726 requires selection of the artery.

    I concur with not using 75726

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