CPC sample question # 4

Procedure Reason: Subdural hematoma. Evaluation for AVM.

Medications: 2 mg Versed IV, 100 mcg Fentanyl IV.

Complications: None.

Contrast: 115 cc of Omnipaque-300.

Risks, benefits, and alternatives to the procedure were explained to the patient and informed written and oral consent was obtained.

A 21 gauge micropuncture needle was used to puncture the left common femoral artery using fluoroscopic guidance. An 018 wire was placed into the artery and over this a 5 French  dilator. A 5 French vascular sheath was placed in the left common femoral artery. Through the sheath, a guidewire and 5 Frence Weinberg catheter were placed into the ascending aorta.
 
Procedure: Contrast was injected, and digital images of the aortic arch were obtained. The catheter was mainpulated to select both vertebral arteries, the right common carotid artery and the left common carotid artery. Contrast was injected in each, with imaging in the head and neck from each selection site.

The catheter was removed, and pressure was applied in the interventional recovery room. Borth extrmities were evaluated for pulse post 30 minutes from the procedure and were normal.

Findings: Aortic arch injections: The origin of the vessels coming off the aortic arch are normal in appearance, with no evidence of stenosis. Right vertebral artery injection: The artery is patent with no stenosis. The posterior fossa vasculature is normal in appearance. The posterior arteries have normal course with no evidence of vasculitis.

Left vertebral artery injection: The artery is patent with no stenosis. The posterior fossa vascu-lature is normal in apperance. The posterior arteries have normal course, with no evidence of vasculitis.

Right common carotid artery injections: No carotid stenosis or evidence of dissection. Imaging of the head reveals a patent anterior communicating and right posterior communicating arteries, with no AVM or aneurysm identified. Normal venous phase is imaged.

Left common carotid artery injections: No carotid stenosis stenosis or evidence of dissection. Imaging of the head reveals a patent anterior communicating and right posterior communicating arteries, with no AVM or aneurysm identified. Normal venous phase is imaged.

Provide the correct procedure code(s) for this procedure.

Impression: Normal four vessel arteriogram.

Answers