Q & A with Dr. Z: Embolization of Access Site
by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC
Question:
“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.
Answer:
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.
