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Embolization - 80-year-old male with history of cholangiocarcinoma

  1. Default Embolization - 80-year-old male with history of cholangiocarcinoma
    Medical Coding Books
    37204
    36247
    36247-59
    75894-26
    75898-26
    75726-26
    75726-2659
    75774-26

    Pls confirm my codes for the below procedure

    CLINICAL HISTORY:
    80-year-old male with history of cholangiocarcinoma
    liver status post right and left biliary drainage catheters.
    Biliary tube change performed yesterday demonstrates communication
    of the left biliary drainage transhepatic tract with the segment
    two branch of the left hepatic artery resulting in hemobilia. The
    patient is now referred for embolization of the segment II branch
    of the left hepatic artery.

    PROCEDURE:

    The right groin was prepped and draped in sterile fashion. A 21
    gauge single wall puncture of the right common femoral artery was
    performed using a Seldinger technique utilizing real time
    ultrasound guidance. A guide wire was passed in retrograde
    fashion. A 5 French vascular sheath was advanced.

    A 4-French Sos selective one catheter was used to select the
    superior mesenteric artery. Contrast was injected and digital
    subtraction angiography was performed. Using a guidewire and
    catheter combination, the origin of the inferior
    pancreaticoduodenal arcade was selected. The catheter was
    advanced and digital subtraction angiography of the inferior
    pancreaticoduodenal arcade (iPDA) was performed.

    A glide wire and glide catheter were manipulated into the inferior
    pancreaticoduodenal arcade (iPDA) and into the gastroduodenal
    artery. The catheter was advanced into the junction of the GDA
    and common hepatic artery. Contrast was injected and digital
    subtraction angiography was performed.

    Multiple different guidewire and catheter combinations were
    attempted to select the left hepatic artery. Eventually, a
    5-French sheath was advanced to the iPDA and a glide wire was used
    to pass a 4-French glide Simmons catheter (tip cut off) to the
    level of the proximal GDA. A renegade microcatheter and double
    angled Glidewire was used to select the segment two branch of the
    left hepatic artery. Transcatheter embolization was performed
    using multiple Nestor and platinum microcoils. A small amount of
    Gelfoam slurry was also injected. There is significant slowing of
    the flow in the segment two branch of the left hepatic artery. A
    coil also was placed in the segment two branch of the left hepatic
    artery.

    Post embolization angiography was performed.

    Following embolization, the right groin sheath was removed and
    hemostasis was achieved with direct mild compression over the
    puncture site. There were no immediate complications.
    Prabha CPC

  2. #2
    Default
    Quote Originally Posted by prabha View Post
    37204
    36247
    36247-59
    75894-26
    75898-26
    75726-26
    75726-2659
    75774-26

    Pls confirm my codes for the below procedure

    CLINICAL HISTORY:
    80-year-old male with history of cholangiocarcinoma
    liver status post right and left biliary drainage catheters.
    Biliary tube change performed yesterday demonstrates communication
    of the left biliary drainage transhepatic tract with the segment
    two branch of the left hepatic artery resulting in hemobilia. The
    patient is now referred for embolization of the segment II branch
    of the left hepatic artery.

    PROCEDURE:

    The right groin was prepped and draped in sterile fashion. A 21
    gauge single wall puncture of the right common femoral artery was
    performed using a Seldinger technique utilizing real time
    ultrasound guidance. A guide wire was passed in retrograde
    fashion. A 5 French vascular sheath was advanced.

    A 4-French Sos selective one catheter was used to select the
    superior mesenteric artery. Contrast was injected and digital
    subtraction angiography was performed. Using a guidewire and
    catheter combination, the origin of the inferior
    pancreaticoduodenal arcade was selected. The catheter was
    advanced and digital subtraction angiography of the inferior
    pancreaticoduodenal arcade (iPDA) was performed.

    A glide wire and glide catheter were manipulated into the inferior
    pancreaticoduodenal arcade (iPDA) and into the gastroduodenal
    artery. The catheter was advanced into the junction of the GDA
    and common hepatic artery. Contrast was injected and digital
    subtraction angiography was performed.

    Multiple different guidewire and catheter combinations were
    attempted to select the left hepatic artery. Eventually, a
    5-French sheath was advanced to the iPDA and a glide wire was used
    to pass a 4-French glide Simmons catheter (tip cut off) to the
    level of the proximal GDA. A renegade microcatheter and double
    angled Glidewire was used to select the segment two branch of the
    left hepatic artery. Transcatheter embolization was performed
    using multiple Nestor and platinum microcoils. A small amount of
    Gelfoam slurry was also injected. There is significant slowing of
    the flow in the segment two branch of the left hepatic artery. A
    coil also was placed in the segment two branch of the left hepatic
    artery.

    Post embolization angiography was performed.

    Following embolization, the right groin sheath was removed and
    hemostasis was achieved with direct mild compression over the
    puncture site. There were no immediate complications.


    I will agree with most of your codes, however, I feel that one branch was selected because of the path of the catheter through the SMA to the GDA to Lt Hepatic. Since the Celiac is not mention, I wonder if it was occluded. So I would go 36247 for selection of the Lt Hepatic from the SMA origion. With the SMA imaged, that would be the visceral charge 75726. The iPDA would be 75774-59 would be the next imaging performed. GDA-Common Hepatic imaging could be 75774-59 since it was selected from the SMA branch, not from the Celiac(?). Then the embolization charge 37204-59 would be next with the S&I 75894-59. Post embolization charge would be 75898. I also wonder about the modifier 26, is the institution where this was performed billing their part of the S&I?

    I hope this helps you out,
    Jim

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