see my repsonses below....
QUOTE=prabha;121835]Please confirm my codes for the below procedure...
50390 no, I would use 36299
76942-2659. no, I would use 76937 instead.
REALTIME ULTRASOUND GUIDED ACCESS OF A PATENT RIGHT COMMON FEMORAL
ULTRASELECTIVE CATHETERIZATION OF THE RIGHT RENAL ARTERY.
TRANSCATHETER EMBOLIZATION OF 2 DISTAL RIGHT RENAL ARTERIES.
FOLLOWUP ANGIOGRAPHY FOLLOWING EMBOLIZATION.
REAL-TIME ULTRASOUND GUIDED ACCESS OF THE RIGHT RENAL ARTERY
ANEURYSM SAC USING A SUBCOSTAL PERCUTANEOUS TRANSRENAL APPROACH.
VIA THIS APPROACH, EMBOLIZATION OF THE RIGHT RENAL ARTERY ANEURYSM
SAC WAS PERFORMED USING MULTIPLE MICROCOILS AND GELFOAM SLURRY.
82-year-old female with history of right renal artery aneurysm
status post embolization 2 years ago now referred for a
angiography and percutaneous intervention.
With the patient in the supine position, the right groin was
prepped and draped in a sterile fashion. Intravenous antibiotics
were administered. Under real-time ultrasound guidance, a 21-gauge
needle was advanced into the right common femoral artery. A 5
French vascular sheath was placed. A 4 French USL catheter was
placed in the right renal artery and selective angiography was
performed. Systemic anticoagulation was administered. Multiple
aliquots of intra-arterial papaverine were administered.
The segmental artery to the upper pole was selected and selective
angiography was performed. Subsequently the distal most branch of
the upper pole segmental artery was selected and the selective
angiography was performed. This vessel was then treated with
transcatheter embolization using embospheres (900-1200 ?: approx.
1.25 cc) and a 4 mm Nestor microcoils. Postembolization
angiography was performed.
A second distal branch of the upper pole segmental artery was
selected. This vessel had been treated with previous transcatheter
embolization. A 3 French microcatheter was inserted into this
vessel and transcatheter embolization was performed using
(900-1200 ?: approx. 1.00 cc) and a 3 mm Nestor microcoil.
Postembolization angiography was performed.
Subsequently, transabdominal ultrasound examination of the right
renal artery aneurysm demonstrated persistent flow. The patient's
care was once again discussed with her son. The possibility of 13
direct percutaneous puncture and embolization of the aneurysm was
discussed. The increased risk of bleeding was also discussed. The
son consented for percutaneous puncture and transneedle
A sterile prep and drape of the right anterolateral abdomen was
performed. Using real-time ultrasound guidance, a 21-gauge needle
was advanced into the aneurysm sac via a trans-renal approach.
Blood return was noted through the needle. Contrast was injected
and the aneurysm sac was opacified. Subsequently multiple 20 mm
and 30 mm diameter coils measuring 100 mm in length were deposited
within the aneurysm sac. In addition 1500 units of thrombin in 1.5
cc saline was injected into the aneurysm sac. Approximately 3 cc
of Gelfoam slurry was also used to embolize the aneurysm sac.
Gentle contrast injection via the needle demonstrated no antegrade
flow in the aneurysm at this time.
Post embolization right renal artery angiography was performed.
The right groin sheath was removed and hemostasis was achieved
with manual compression over the puncture site.
The right renal artery is patent and demonstrates a large (3 cm)
renal artery aneurysm in the region of the right upper pole. There
is evidence of previous transcatheter coil embolization of distal
branches of the right renal artery. Multiple collateral vessels
are identified distal to these coils and continued to feed the
aneurysm. Two feeding branches of the aneurysm originated from the
segmental artery to the upper pole.
Ultraselective of catheterization of the lateral most distal
branch of the upper pole segmental artery was performed and
demonstrates opacification of a branch that supplies some of the
upper and lateral normal renal parenchyma. Transcatheter
embolization was performed distal to this branch. Embolization was
performed using embospheres and coils.
Subsequently a second distal branch of the upper pole segmental
artery was catheterized and an ultraselective fashion. This
branch also demonstrated flow to the aneurysm via multiple
tortuous vessels but also demonstrated coils within them. Despite
the presence of these coils there is flow distal in these branches
with subsequent reconstitution of the aneurysm. This vessel was
treated with transcatheter embolization with embospheres and
Postembolization angiography demonstrates slowing of vessels
supplying the aneurysm but persistent opacification of the
At this time direct puncture of the aneurysm was discussed with
the patient's son. The patient's son wished for our team to
proceed with further intervention.
Using real-time ultrasound guidance, a 21 gauge needle was
directly passed into the aneurysm sac. Multiple vein of Galen
microcoils were placed in the aneurysm. Gelfoam slurry and a small
amount of thrombin was placed in the aneurysm to promote
No further flow was demonstrated in the aneurysm with duplex
Right renal angiography demonstrates no further opacification of
branches supplying the aneurysm. There is preservation of flow to
a distal branch of the upper pole segmental artery as well as mid
and lower pole segmental arterial branches of the main right renal
Large (3 cm) renal artery aneurysm with supply from previously
embolized branches of the distal segmental artery to the right
Ultrasound of catheterization and angiography of distal branches
of the right upper pole segmental artery using particles and coils
resulting in slowing of antegrade flow in the aneurysm.
Real-time ultrasound guided access of the aneurysm sac via a
Via this tract aneurysm sac access, embolization of the aneurysm
sac was performed using coils and Gelfoam as described above.[/QUOTE]
Danny L. Peoples