Ask Dr. Z

Are the angiographies billable with these two procedures? "(A) Y90 WORK UP: Selective arteriography of the celiac, SMA and replaced RT hepatic artery with a large tumor blush in RT hepatic lobe corresponding to tumor seen on recent MRI, fed by branches of replaced RT hepatic artery. 3D cone beam CT from replaced RT hepatic artery show the large RT hepatic lobe mass seen on prior CT. Infusion of MAA into RT hepatic artery was performed. (B) IMPLANTATION: TACE X 2 with follow-up MRIs showing bilobar treatment changes with new/enlarging residual viable tumor in LT hepatic lobe and segment 7/8. Selective celiac arteriogram: truncation of PHA with vessels that supply the tumor in LT hepatic lobe arising from LT gastric artery; selective CHA/cystic arteriograms: small vessels arise from cystic artery which takes off from proximal GDA; and selective LT gastric arteriogram: accessory LT hepatic artery with multiple small vessels supplying the known lesions in hepatic segment 2/3. Radioembolization of the parasitized vessels arising from his cystic artery and small branches supplying the gastric fundus was performed."