Q & A with Dr. Z: Embolization of Access Site

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC

“After cardiac ablation procedure had been completed, attention was then turned access closure. Given large size of the transhepatic sheath required for ablation, with direct communication with the systemic vasculature, access site embolization was necessary to prevent hemorrhage on sheath withdrawal. Then after diagnostic venogram of the right hepatic vein performed. Venogram demonstrates brisk central outflow from the right hepatic vein to the IVC, with the site of venous access identified as mild luminal irregularity at the sheath tip encountered on slow sheath withdrawal. Embolization of the venous access site was then performed through the microcatheter with a 6 mm x 20 cm Ruby Soft detachable microcoil, with tight coil packing extending into the hepatic tract, confirmed with ultrasound.”

I’m not sure what to code for embolization here. Please advise.

Closure of a transhepatic access is not separately reportable. Do not report as an embolization. Venography of the hepatic vein to IVC is not reported either. Similar to a femoral access site, there is no code for imaging for closure and no code for embolization of the access.


Coding Basics for Vascular Coding
Catheter placement coding today is integral to IR, endovascular, and cardiovascular procedures. Important concepts including the concept of vascular families, the importance of variant anatomy, and selective vs. non-selective catheter placements are taught. There is also a discussion of S&I codes that must be performed selectively and S&I codes that include catheter placements. Learn more here.

Disclaimer: This article is written for educational purposes only. Every reasonable effort has been made to ensure its accuracy and completeness. It is the responsibility of the reader to refer to the definitions, descriptions, conventions, and guidelines specific to each coding classification, as well as relevant laws and regulations when selecting and reporting medical codes.

About the Author

David Zielske is founder and President of ZHealth Publishing and primary author and editor of ZHealth publications. Dr. Z practiced as an interventional radiologist and has over twenty years experience as a coding reviewer and coding expert. He is Board Certified in Radiology and has functioned as an independent interventional radiology, vascular surgery, and cardiovascular coding consultant to a variety of physician groups and hospital providers across the country. He also served as an instructor for over 200 coding seminars.

Leave a Reply