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Endosvascular retrieval of migrated coil from LT pulmonary artery

Date: Nov 25, 2014

Question:

ESRD pt w/hx of coiling of a branch vein originating from immature AV fistula w/coil migration to the RT heart. RT CFV was punctured w/ placement of 7 French sheath, pigtail cath advanced over Bentson guidewire into descending branch of LT pulmonary artery (36014), contrast injected & imaged showing coil lodged at bifurcation of descending pulmonary artery branch. A 9-15 mm EN-snare was used to capture end of coil & retracted into RT iliac vein & as it was pulled into the sheath began to unravel. Sheath removed, unraveled wire clamped w/hemostat. Maln coil mass was still in iliac vein. CFV was punctured a 2nd time, slightly higher than initial puncture. 7 French sheath was placed & coil mass then easily captured with snare & removed. (36000-59) The other guidewire fragment was cut at the skin & removed through the 2nd venotomy. Imaging confirmed complete removal of the coil. (37197) Will codes 37197, 36014, and 36000-59 accurately represent this procedure? Clinic says 36005 should be charged, not 36000-59. Which do you advise?

Question ID : 6213
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