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Stent vs. embolization?

  1. #1
    Richmond Virginia
    Default Stent vs. embolization?
    Medical Coding Books
    Right groin was prepped and draped in a sterile fashion. Using a
    Doppler guided access needle the right common femoral artery was
    entered and a JB1 angiographic catheter was advanced to the aortic
    arch. Selective catheterization of the right subclavian artery was
    performed. A 70 cm long 6.0 French vascular sheath was inserted. The
    JB1 angiographic catheter was then subselectively advanced into the
    subclavian artery, after placement of a TAD 0.018 platinum tip
    guidewire this catheter was then exchanged for a 6 French Neuron
    guiding catheter which was positioned in the upper right vertebral
    artery, above the skull base. Moderate vasospasm was noted and
    intra-arterial verapamil was administered. The Neuron catheter was
    used to provide stability to a 150 cm long Renegade microcatheter
    which was advanced over a Synchro pre-shaped angled guidewire and
    into a distal posterior cerebral artery branch on the left through
    the left P1 segment. Additional vasospasm was noted and additional
    intra-arterial verapamil was administered at this point. A Neuroform
    4.5 mm expanded diameter 20 mm long intracranial stent was then
    positioned with the distal aspect of the stent near the distal P1
    segment and the proximal aspect of the stent in the distal basilar
    artery, and deployed. An Excelsior 10 microcatheter was advanced over
    a Synchro standard pre-shaped guidewire and the interstices of the
    Neuroform stent were crossed entering the basilar artery aneurysm.
    Endovascular coiling of the aneurysm was then carried out as
    described below. Additional followup angiography was then performed
    as described. At completion an AngioSeal vascular closure device was
    applied to the right common femoral artery with complete hemostasis.
    The patient was then taken to PACU and subsequently to the
    neuroscience ICU.



  2. #2
    Alexandria, LA
    The recommendation is to code only for the embolization when the neuroform stent is placed at the same session as the embolization. The stent in this case is really part of the embolization process.

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