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MESENTERIC ANGIOGRAM

Stephnaie Posted Mon 03rd of February, 2014 16:07:27 PM

Can you please help me with the CPT codes for this report:
Mesenteric angiogram 01/30/2014.

History: GI bleed.

PROCEDURE IN DETAIL:
The patient was brought to the angiographic suite and placed in supine
position. The left groin along with the indwelling left common femoral
venous and arterial catheters were prepped and draped usual sterile fashion.
1% lidocaine was utilized for local anesthesia.

Through the indwelling left common femoral arterial line, a 0.018 wire was
inserted and advanced to the left common iliac artery. The catheter was
removed and a 5-French micropuncture catheter was inserted into the left
common femoral artery. Both the inner dilator and wire were removed and a
0.035 Benson wire was advanced into the abdominal aorta. The micropuncture
catheter was exchanged out for a 6-French short sheath.

Next, a 5F Mickelson catheter was advanced over a wire and formed in the
thoracic aorta. This was then brought down to the inferior mesenteric
artery. A hand contrast injection was performed to confirm appropriate
placement. However, subsequent stasis of contrast in the proximal inferior
mesenteric artery was noted, and with suspected to be resultant from
vasospasm. This did not resolve after several minutes. Due to the patients
low blood pressures, it was decided to forego vasodilator administration at
this time and proceed to interrogate the other mesenteric arteries before
interrogated the IMA, once again.

The Mickelson catheter was disengaged and then placed at the superior
mesenteric artery. Digital subtraction angiogram was performed demonstrating
normal caliber superior mesenteric artery branches. No active extravasation
was visualized. No abnormal arteriovenous shunt is noted. The superior
mesenteric venous branches are patent.

The catheter was disengaged and advanced to the inferior mesenteric artery. A
column of contrast remained at the proximal inferior mesenteric artery.
Therefore, intra-arterial nitroglycerin 200 mcg was administered through the
Mickelson catheter into the IMA followed by a saline flush. After several
minutes, the column resolved. A digital subtraction angiogram was performed,
demonstrate normal caliber. IMA branches. No abnormal extravasation is
seen. No early filling venous branch is noted. Appropriate flow in the
inferior mesenteric venous branches is seen.

Over a wire, the Mickelson catheter was exchanged out for a 5F Chuang B
catheter. The new catheter was utilized to select the celiac trunk. Digital
subtraction angiogram performed demonstrating normal configuration of the
celiac trunk branches without active extravasation. Appropriate later flow
in the splenic vein and portal vein is seen.

The Chuang B catheter was removed. Saline was utilized to aspirate and flush
the side arm of the 6-French short sheath. The sheath was secured skin
utilizing nonabsorbable suture for utilization as an arterial line by the
critical care seen. A sterile bandage was applied.

The patient tolerated procedure well with no immediate complication.

IMPRESSION:
Diagnostic arteriograms of the celiac trunk, SMA, and IMA performed. No
source for the rectal bleeding was identified.

SuperCoder Answered Tue 04th of February, 2014 09:24:16 AM

Please contact Manney at Customer Service at 866-228-9252 Extn : 4165

Thanks,

Stephnaie Posted Wed 05th of February, 2014 12:10:19 PM

This phone number is not working. Do you have another contact number? We need this ASAP!

SuperCoder Answered Wed 05th of February, 2014 16:29:11 PM

I will ask the CS to call you.

Thanks,

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