Ask Dr. Z

Patient is past type A dissection repair with ascending tube graft. He subsequently had TEVAR for residual dissection repair during the same hospitalization. He is being followed for chronic residual dissection, and on CT scan was noted to have persistent endoleak with perfusion of the lumbar vessels in the false channel where the majority of this aneurysmal enlargement is. Patient now comes for embolization and thoracic stent graft extension to the celiac artery. “The celiac artery was marked on IVUS, and a CTAG Gore stent graft was then advanced and deployed just above the celiac artery. Access was obtained into the false lumen, and non-selective aortography showed endoleak from intercostal vessels, which is keeping the retrograde flow in the false lumen intact. We catheterized the endoleak channel and the nidus and deployed several 8 x 4 mm Tornado coils and then deployed an additional 12 mm Amplatzer plug within the endoleak channel.” Is this initial 33881 or extension 33886 for the residual dissection? Also what’s the code for cath for embolization? Is this 36200?