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Dr. Z please advise on the coding for this case. Here are the codes I came up with but I am not sure about the catheter placement for the direct access to the superior gluteal and whether the imaging can be coded as 75736 since that has to be selective and this was a direct puncture. I am coding for the physician.Thanks so much for your feedback. 36200, 36140-59, 75625-59, 37204, 75894, 75898, 75736-59. Hx of left internal iliac artery aneurysm/pseudoaneurysm. Inflow internal iliac artery previously treated with covered stent. Continued enlargement of the mostly thrombosed sac, pt remains symptomatic from mass effect. CT evidence of continued sac pressurization from the superior gluteal artery retrograde flow. Left common femoral artery was accessed with ultrasound guidance. A 5-French straight flush catheter was positioned at the aorta bifurcation to left common iliac artery. Pelvic angiogram redemonstrates the ulcerated plaque with pseudo aneurysmal dilatation of the distal abdominal aorta and diseased but widely patent common and external iliac arteries bilaterally. The left common to external iliac artery covered stent is widely patent and the left internal iliac artery origin is well occluded. The right internal iliac system is widely patent. The targeted gluteal branch is seen to reconstitute via numerous tiny presacral cross pelvic collaterals. No collateral vessel reconstituting the embolic target is navigable to achieve access from an antegrade endovascular approach. Therefore, the patient was rolled prone oblique, left buttock up. The terminal bifurcation of the left superior gluteal artery was accessed just external to the sciatic notch outside the bony pelvis using ultrasound and fluoroscopic guided micropuncture. An angiogram was performed which demonstrates access in the patent superior gluteal artery, and evidence of a short branchless proximal segment culminating in a pulsating pouch of perfusion within the larger thrombosed aneurysm sac. Using a renegade microcatheter, the sac perfusion and the branchless segment leading up to it were successfully coil embolized using numerous 3 to 6 mm coils. Post embolization angiogram was performed from the directly accessed superior gluteal artery demonstrating excellent occlusion, no further retrograde supply to the aneurysm sac.