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Y-90 Preliminary Workup

Date: Dec 1, 2014

Question:

Is it appropriate to add an extra cpt code of 36248 for the proper hepatic when a diagnostic arteriogram if performed?

The celiac was selected,type 1 celiac anatomy, selected common hepatic, , The G.D. was selected. To prevent reflux and nontarget embolization in the GDA. The cath was positioned in the proper hepatic artery, an arteriogram was performed. The r. gastric artery was identified arising from the r. hepatic artery. This was selected microcath, arteriogram done. To prevent reflux & nontarget embolization into the RGA, the RGA was occluded with coils. The cath was directed deeper in the r. hepatic artery, arteriogram was performed. 1.5 mCi of tech 99 MAA was infused into the r. lobe. The cath was then directed into the l. hepatic artery. 2.5 mCi of tech 99 MAA was infused in the l. lobe. Codes used: 37242,36247(G.D.),36248X4(proper hepatic, r. gastric, r. hepatic, l. hepatic) & 79445. My understanding is we can add a 36248 for the proper hepatic, because they stopped at this level to do a diagnostic arteriogram. If the cath was going from the proper to the hepatic, not stopping to do an arteriogram of the proper hepatic, then we would pick the highest cath placement?

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