Under roadmap imaging after double flushing, the Envoy catheter was advanced
into the proximal cervical right internal carotid artery where it was
used for 3-D rotational right carotid cerebral angiography. The Envoy
catheter was then connected to heparinized pressurized saline flush
using a Tuohy Borst connector and in line Pall air filter. Working
projections and measurements were obtained of the azygos pericallosal
aneurysm’s patent compartment. A 150 cm in length 6 cm distal segment
Excelsior SL 10 microcatheter with two markers in its tip and a 45
degree curve in its tip had 2 curves steamed proximal to its tip. The
Excelsior SL 10 microcatheter was advanced over a 200 cm in length 45
cm distal segment Synchro 14 microguidewire through the Envoy catheter
into the right internal carotid artery, then the right anterior
cerebral artery, and placed in the azygos pericallosal aneurysm. The
Excelsior SL 10 microcatheter was connected to heparinized pressurized
saline flush using a Tuohy Borst connector and in-line Pall air filter
after double flushing. The following coils were placed within the
recurrent azygous pericallosal aneurysm: 2 mm x 2 cm extra soft
Penumbra SMART with deployment started at 10:51, detached at 11:11
with satisfactory compartment framing and no microcatheter kickback
followed by placement of a 1 mm x 1 cm extra soft Penumbra SMART coil
with placement started at 11:18 and detached at 11:27:30, with a small
amount of microcatheter kickback into the parent lumen of the azygos
pericallosal artery. Two limited right carotid cerebral angiograms
were performed after placement of each of the Penumbra SMART coils
using the Envoy catheter. The Excelsior SL 10 microcatheter was
removed over the Synchro-14 microguidewire. Completion right carotid
cerebral angiography was performed using the Envoy catheter.
My provider wants to bill 36224, 76377 (both of which i agree with) 61624, 36217, 36218, 75898 X 3, 75894. I agree with all but the 36218. Can anyone explain why we would bill the 36218?
francine
