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HOW do we code chemoperfusion, catheter placements, angiographies, and chemo administration intra-arterial for the case that follows?

INTERPRETATION: Clinical History: Advanced parotid cancer. Procedure: Informed consent was obtained, which included a discussion of possible complications including but not limited to bleeding, stroke, non-target chemoperfusion, arterial injury, and contrast reaction. The patient was placed in the supine position and the right groin prepped and draped in sterile fashion. Physiologic monitoring was performed throughout the procedure. Moderate sedation was provided for three hours. Chemotherapy to be delivered intra-arterially included the following: 5FU 500 mg diluted with contrast, Gemzar 1000 mg (20 mg/cc) diluted with contrast and Oxaliplatin 100 mg diluted with contrast. The right common femoral artery was accessed with a micropuncture set, and a 5 French vascular sheath was placed. A 5 French pigtail catheter was advanced to the ascending thoracic aorta, contrast injected, and digital subtraction arteriography (DSA) performed. This catheter was exchanged for a 5 French H1 catheter, which was positioned into the right subclavian artery with contrast injected and DSA performed. A microcatheter was advanced coaxially and placed into the right costocervical trunk, with contrast injected and DSA performed. Two thirds of the chemotherapy was administered into this trunk. The H1 catheter was then positioned into the right common carotid artery and DSA performed in the lateral projection of the neck. A microcatheter was positioned into the right facial artery and DSA performed. The remaining one-third of the chemotherapy was administered. The catheter and sheath were removed, and hemostasis was achieved using manual compression. The patient tolerated the procedure well and left the department in satisfactory condition. There were no immediate complications. Findings: There is classic branching of the thoracic aorta. The visualized portion of the innominate, left carotid, and left subclavian arteries are widely patent. There is extensive tumor vascularity supplied by branches of the right costocervical trunk over the periclavicular area, which is the region of known tumor. Two thirds of the chemotherapy was administered in this location. The common, external, and internal carotid arteries are widely patent. A smaller area of tumor vascularity is supplied by the right facial artery. The remainder of the chemotherapy was administered into this vessel. A moderate narrowing is seen in the proximal lingual artery. Impression: Chemoperfusion of right parotid cancer metastatic to the right upper chest and lower neck as described.