|
Here is your ZHealth
Coding Newsletter for January 2007: a recent
coding question submitted by one of our
ZHealth
Online
members – and Dr. Z’s answer:
Coding
Question:
What is a digital subtraction rub-out? Is this
codeable? Again, is it appropriate to code 75774 x 2 for
the bilateral uterine arteriograms? I do not see
specific interpretations of the uterine arteries except
for post-embolization. My codes are:
37204/75894; 36247 x 2; 75736 x 2; 75898 x 2;
75730. Thanks in advance for your expert
advice!
PROCEDURE:
1.Pelvic Arteriogram. 2.Bilateral uterine artery
embolization with 500 to 700 micron size hemisphere
particles.
INDICATION:
40-year-old female with multiple symptomatic
uterine
fibroids
producing menorrhagia/dysmenorrhea.
TECHNIQUE:
Written informed consent was obtained.
The patient was sterilely prepped and draped.
Using a micropuncture access set the right common
femoral artery examined without difficulty. A 5 French
vascular sheath was placed. Under fluoroscopy a 5 French
Omni-flush catheter is advanced over a 035 J guide wire
and catheter was reformed in the proximal abdominal
aorta. The catheter was pulled down in the aortic
bifurcation and contrast was injected during digital
subtraction arteriography of the pelvis in the AP
projection. Digital subtraction
rub-out was performed. An 035 Benson wire was advanced
through the Omniflush catheter into the contralateral
left common iliac. Subsequently the external iliac and
finally the left common femoral artery.
The Omniflush catheter was removed. A 5 French
RUC cap was advanced over the wire reform.
The catheter was then used to selectively
catheterize the contralateral left internal iliac
artery and
subsequently the anterior division of the left internal
iliac artery. A digital subtraction
arteriogram was performed in the AP projection. The
catheter was then used to selectively catheterize
the proximal left uterine artery and a left uterine
arteriogram was performed again in the AP projection.
Digital subtraction rub-out was performed. The catheter
was advanced through the mid uterine artery segment and
a total of two syringe volumes of the 500 to 700 micron
size hemisphere particles was administered during a
negative digital subtraction road map using meticulous
fluoroscopic technique. Post embolization the catheter
was advanced back into the anterior division left
internal iliac artery and a repeat post embolization
arteriogram was performed in the AP
projection. The catheter was then
backed back into the abdominal aorta and then used to
selectively catheterize the ipsilateral right common
iliac and subsequently internal iliac artery. The
anterior division of the right internal iliac artery was
selected and a right internal iliac arteriogram was
performed in the AP projection.
Visual subtraction road map was performed and the
catheter was used to collectively catheterize the right
uterine artery proximally. A right
uterine arteriogram was performed in the AP
projection. Digital subtraction rub-
out was performed and the catheter was advanced to the
mid right uterine artery segment and an additional
syringe of 500 to 700 micron size hemisphere particles
was again administered using a meticulous technique
under a negative digital subtraction road
map. After embolization the catheter
was backed into the right anterior
division of the internaliliac artery and repeat
arteriogram was performed post embolization again in the
AP projection. The catheter was backed into the
abdominal aorta and then removed over a 3 J
wire. A right femoral arteriogram was
performed through the 5 French vascular
sheath. The sheath was removed and
exchanged for a 6 French Star Close closure device which
was deployed for hemostasis.
There were no procedural
complications.
CONCLUSION:
1.
THERE IS A MODERATELY ENLARGED UTERUS CONTAINING
TWO DOMINANT BUT OTHER
MULTIPLE HYPERVASCULAR UTERINE MASSES CONSISTENT WITH
THE PATIENT'S KNOWN UTERINE FIBROIDS.
THESE WERE SUCCESSFULLY EMBOLIZED WITH 500 TO 700
MICRON SIZE HEMISPHERE PARTICLES WITH A TOTAL OF TWO
SYRINGE VIALS IN THE LEFT UTERINE ARTERY AND ONE IN THE
RIGHT UTERINE ARTERY. POST
EMBOLIZATION ARTERIOGRAMS REVEAL STAGNANT FLOW IN THE
LEFT UTERINE ARTERY POST EMBOLIZATION AND SLOW ANTEGRADE
FLOW IN THE RIGHT UTERINE ARTERY POST EMBOLIZATION AS
DESIRED.
2.
THE DISTAL DILATED AORTA AS WELL AS THE COMMON
ILIAC AND EXTERNAL ILIAC ARTERIES BILATERALLY ARE WIDELY
PATENT WITHOUT EVIDENCE FOR
AORTOILIAC STENOSIS OR ANEURYSMAL
ENLARGEMENT.
3.
THE LEFT AND RIGHT INTERNAL ILIAC ARTERIAL
BRANCHES SHOW CLASSIC ARTERIAL
ANATOMY WITHOUT EVIDENCE FOR STENOSIS, ANEURYSM, FILLING
DEFECT, FISTULA OR MALFORMATION.
4.
THE PATIENT WILL BE TRANSFERRED TO RADIOLOGY
NURSING FOR OBSERVATION AND PAIN
CONTROL. THE PATIENT WILL BE ADMITTED
FOR OVERNIGHT OBSERVATION AGAIN FOR
PAIN CONTROL PURPOSES.
Dr Z’s
Answer:
First of all, I have not heard of a digital
rub-out before, but, my guess is that it is a new term
for digital subtraction angiography...which is
angiography. Now, for the coding of
this procedure, always be willing to change!
I may have used many of the codes suggested 2
years ago, only codes 37204, 75894,
75898 and 36247-50 last year, but now that it is 2007, I
would only code
the new comprehensive code 37210.....(and G0269 for the
closure device placement). After
several years of work, the SIR has helped develop along
with the AMA a new, all-inclusive code for treatment of
uterine fibroids by percutaneous embolization technique.
This new code for use in 2007 includes all catheter
placements, diagnostic angiography, the embolization and
follow-up exams.
2007
ZHealth Coding Seminars—still time to sign up for
Phoenix
Phoenix
is a great place to be in February! Here’s our complete
schedule of ZHealth Coding Seminars for
2007:
Sign up today for a 2007 ZHealth
Coding Seminar and receive a free a copy
($295 value) of the new 2007 Dr. Z's Interventional
Radiology Coding Reference.
Three
NEW 2007 ZHealth Publications
Each one of
these three new publications is THE
most current, comprehensive and invaluable
coding reference available for all professionals
involved in the complex world of coding interventional
radiology, vascular, endovascular, and cardiology
procedures. Remember that ZHealth Online members receive 10% off
the purchase of any books or conference registrations.
Order
your coding references today. We are going to start
shipping our first two 2007 coding books this month:
Dr. Z’s Medical Coding
Series: Interventional Radiology Coding
Reference: 2007 Edition – Release date: January
2007
Dr. Z’s Medical Coding
Series: Vascular & Endovascular Coding
Reference: 2007 Edition – Release date:
January 2007
Dr. Z’s Medical Coding
Series: Interventional Cardiology Coding
Reference: 2007 Edition – Release date: March
2007 (not pictured at right).
Let us know if you have
any questions about the new books.
| 
