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Help with a Spine embo case

  1. #1
    Question Help with a Spine embo case
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    My Neuro IR MD dictated this on an angio spinal with embo and I am verifying the codes on this case.
    1. Right pulmonary artery angiography/right T8 angiography
    2. Selective right T4 angiography
    3. Right T3 angiography
    4. Left pulmonary artery angiography
    5. Right T5 angiography
    6. Bilateral T6 and T7 angiography
    7. Left T3 angiography
    8. Left T4 angiography
    9. Left T5 angiography
    10. Embolization of tumor supply from bilateral T4 and T5 intercostal arteries
    11. Control angiography from bilateral T4 and T5 intercostal arteries post embolization

    Findings: Selective injection of the multiple bilateral lintercostal arteries extending from T3 to T7 was performed demonstrating the following findings: Significant supply to the T5 lesion was seen from bilateral T4 and T5 intercostal arteries. There was also supply to the anterior spinal artery from the right T4 intercostal artery. The pulmonary arteries were found to be normal. No additional sources of supply were seen.

    Injection of the right T3 branch demonstrated enhancing metastasis to the right at T2. Several small enhancing metastases were seen and T4 level. The source of supply from left T4 , and bilateral T5 intercostal arteries were embolized after endovascular ciipping of the muscular branches followed by particle embolization with PVA. This resulted in excellent occlusion of tumor supply from at elast 3 branches.

    A microcatheter was advanced into the right T4 and additional angiography was performed. The supply to the tumor was noted to be from a Corporeal branch of the intercostal artery which was selectively microcatheterized. This was carefully embolized with PVA taking care not to reflux particles back into the main intercostal trunk.

    A control angiogram post embolization demonstrated patency of the radiculomedullary artery and the anterior spinal artery. It also demonstrated good devascularization of tumor supply from right T4.


  2. #2
    Assuming a femoral approach was utilized you would code 75705x11, 36215x11, 37204, 75894, & 75898. The pulmonary arteries are mentioned in the top of the report however the body of the report does not support selective cath and a true diagnostic study of bilat pulmonary arteries so I would be reluctant to bill for that portion without an amended report.
    Gotta love the intercostal angios.....soooooo many codes for such a short report!!!
    Anita W, CIRCC, RCC, CPMA, CPC

  3. #3
    I did not want to code the pulmonary either because of how the dictationi stated.
    Thank you very much for the assistance. These are so much fun, not?! Liza

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