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Status post EVAR eight years ago with Type

  1. Question Status post EVAR eight years ago with Type
    Medical Coding Books
    Status post EVAR eight years ago with Type
    II leak and aneurysm enlargement on CT.
    right common femoral artery was punctured with a 19 gauge needle
    and a 5 French sheath introduced over a Newton J. wirre. Through
    this and Omniflush catheter was positioned first above the top of
    the graft and then in the graft to assess for a leak. A third
    injection was performed in the right limb.The catheter was then
    exchanged for a Sos catheter and selective injections performed on
    the left limb. The catheter was then manipulated into the superior
    mesenteric artery and an injection performed.
    Findings. Abdominal aortogram.

    There is no evidence of a leak at either end of the device, nor is
    then a defect in the graft.

    An injection in the right limb iin 2 obliques demonstrates no Type
    IIb leak. The hypogastric artery is patent but does not opacify
    the leak seen on CT.

    Injections in the left limb of the graft again demonstrated no Ib
    the leak. There is a large deep circumflex iliac which
    contributes a vessel which probably supplies the leak. There is a
    surgical graft from the external iliac artery to the hypogastric
    artery and the iliolumbar artery appears to supply a vessel to the

    Superior mesenteric arteriogram.
    CPT codes:
    can i give 75736 for left limb (graft)injection and angiography of pelvic vessels (Since it can be used only with selective catheterization of internal iliacs)


  2. #2
    it's hard to tell if the internal iliac was actually "selected" to do the injection. Was the left limb in the internal iliac artery? If it was, then I would say yes to the 75736. If you're not sure, I would check with the physician and have him addend the report to say so. You might just end up with a 75710.
    hope that helps!

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