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Hi Dr Z.one of our interventionalists does this procedure frequently for Liver Ca and I'm having trouble getting it coded correctly. I hope you will be able to help. I use your book when I code these but I would like some validation that I'm using the right codes. PROCEDURE: 1. Superior mesenteric artery angiogram. 2. Accessory right hepatic artery angiogram arising from the superior mesenteric artery. 3. Celiac artery angiogram. 4. Selective left gastric artery angiogram. 5. Selective gastropancreatic common trunk angiogram. 6. Coil embolization of this common pancreatic gastric trunk. 7. Selective left hepatic artery angiogram of two segmental left hepatic arteries. 8. Selective right hepatic artery angiogram. 9. Gastroduodenal artery angiogram. 10. Coil embolization of the gastroduodenal artery. 11. MAA infusion of approximately 2.5 mCi Tc 99m MAA into the accessory right hepatic artery arising from the superior mesenteric artery. 12. MAA infusion of approximately 2.5 mCi Tc 99m MAA into the right hepatic artery arising from the celiac artery. DESCRIPTION OF PROCEDURE: The patient was laid supine. The right groin was prepped and draped in the usual sterile fashion. Skin and deep subcutaneous soft tissues were anesthetized with 1% Lidocaine. A small skin nick was made with a #11 blade, and then using micropuncture technique, the right common femoral artery was accessed and a microwire advanced. Over the microwire a #5-French microsheath was placed. Through the microsheath an 0.035 3-J wire was advanced into the abdominal aorta, and over the wire a #5-French working sheath was placed. Over the wire and through the sheath, a #5-French Sos Selective catheter was placed over the wire and formed in the abdominal aorta. It was then used to select the superior mesenteric artery and a digital subtraction superior mesenteric artery angiogram was performed, and using a Progreat microwire and microcatheter, the microwire and microcatheter were used to select the accessory right hepatic artery arising from the superior mesenteric artery proximally. A digital subtraction right accessory hepatic artery angiogram was performed, which showed dominant supply to a hypervascular complex right-lobe-of-liver mass along with several satellite lesions. The accessory right hepatic artery supplies a moderate amount of the right lobe of liver, likely greater than half of it. Next, the microcatheter was removed and the Sos selective catheter was used to select the celiac artery. Digital subtraction celiac artery angiogram was then performed. This reveals a complex configuration of celiac artery with two left gastric arteries arising from the bifurcation of the common hepatic and splenic as well as a very large pancreatic gastric trunk. Using Progreat microwire and microcatheter, the wire was used to select the left gastric artery, and a digital subtraction left gastric artery angiogram was performed. Then using Progreat microwire and microcatheter, the gastric pancreatic trunk was selected. This comes off in a trifurcation fashion with gastroduodenal right and left hepatic branches. This pancreatic gastric trunk was selected and then back- coiled with 0.018 Vortex microcoils to complete stasis. Hand-injected arteriogram was performed documenting the adequacy of embolization. Next the left hepatic artery was selected. There are two left hepatic arteries, the segment two branch first was selected and digital subtraction angiogram performed. Next the segment three branch was selected and digital subtraction angiogram performed. Next right hepatic artery was selected and right hepatic artery angiogram was performed, which showed a branch vessels supply to part of the hypervascular dominant right-lobe-of-liver hepatocellular carcinoma. Next the gastroduodenal artery was selected and a digital subtraction gastroduodenal artery angiogram was performed. This was then coiled to complete stasis using Nestor microcoil as well as Azure detachable coil. The gastroduodenal artery was coiled to complete stasis and a post-coiling angiogram was performed documenting adequacy of embolization. Next the catheter was brought into the proper hepatic artery upstream to the trifurcation of vessels. 2.5 mCi Tc 99m MAA was then infused at this site. Delivery materials were then safely disposed of by the nuclear medicine technologist. A new Progreat microwire and microcatheter were placed after the Sos Selective catheter was used to select the superior mesenteric artery. Microcatheter was then used to select the accessory right hepatic artery, and the remaining dose of MAA was injected. 2.5 mCi Tc 99m MAA were injected into the right accessory hepatic artery. Infusion materials were then removed and safely disposed of by nuclear medicine technologist. The right groin sheath was then removed and excellent hemostasis achieved using manual compression for about 15 minutes. My codes are 37204 and 37204-59, 75894, 75894-59, 36245, 36246, 36247-59x3, 36248 x's3.

Thanks for your help in advance