IR( interventional radiology)-1

                                            IVR/IR

IVR, IR, or interventional radiology also referred to as surgical radiology is a specialty of radiology that uses image-guided procedures to treat and organize diseases. The concept behind IVR is to treat patients easing the least invasive techniques to minimize the risk and improve health conditions.

Using x-ray CT ultrasound MRI other imaging modalities radiologists obtain images to guide instruments into the body. Generally, procedures that are performed using needles and narrow tubes called catheters.

Many procedures that once required large incisions can now be treated non-surgical by interventional radiologists minimize the patient's physical trauma, reduce infection rates and recovery time and hence shorten hospital stay.




Tips:
1. All IVR procedures performed percutaneously.
2. This is a Minimal invasive procedure.
3. It is performed by Using Imaging guidance. The images used as Road maps.
4. The technology includes the use of balloons, catheters, microcatheters, stents, therapeutic embolization (deliberately clogging up a blood vessel), and more.
5. It may be a Diagnostic procedure (e.g. Angiogram) or a Therapeutic procedure (e.g. Angioplasty).
6. IVR codes:
Injection (or) Procedure code.
S&I (or) Guidance code.
7.S&I- Supervision, and Interpretation.

Different types of IVR procedures:-

Biopsy
Fine needle aspiration
Thoracentesis.
Paracentesis (Peritoniocentasis).
Hysterosalpingogram.
Urinary procedures
Breast procedures.
Joint procedures.
Spinal procedures.
Line placements.
IVC filter placement.
Drainage procedures.
Gastrointestinal procedures.
Biliary procedures.
Ablation procedures.
Catheterization procedures.
Angiography
Angioplasty and stent placement
Embolization and Chemoembolization
Thrombolysis
TIPS catheter placements.

A)Biopsy:-

Definition:-

Doctors remove the sample from the targeted tissue or remove the whole tumor via a
sterile needle. Then a specialist will examine the sample tissue under the microscope called a pathologist.

Percutaneous biopsy is minimally invasive to collect tissue through needles with help of image guidance.

Image-Guided Biopsy:-It combines an imaging procedure such as an X-ray, CT, MRI,
or US with a needle biopsy. Using real-time images, your doctor can make sure the needle reaches the correct spot. 

Surgical Biopsies example:-

Muscle or soft tissue, percutaneous -20206
Bone, superficial, percutaneous(eg, ilium, sternum, spinous process, ribs) -20220
Bone, deep, percutaneous(eg, vertebral body, femur) -20225

Biopsy, pleura, percutaneous needle-32400
Lung/ Mediastinum, Percutaneous -32405

Diagnostic bone marrow biopsy-38221

Diagnostic bone marrow biopsy and aspiration(s)-38222
Lymph nodes, superficial, percutaneous(eg, cervical, inguinal, axillary) -38505
A liver, percutaneous, a separate procedure -47000

Biopsy of the pancreas, percutaneous needle-48102
Abdomen/Retroperitoneal, Percutaneous -49180
Renal (Kidney), Percutaneous -50200 

Biopsy, prostate needle or punch-55700
Renal Cyst, Percutaneous -50390
Thyroid, Percutaneous core needle -60100 

B) Fine Needle Aspiration:

Definition:- A needle was placed into the target location to collect the fluid or tissue.

10021+10004 -Fine needle aspiration biopsy, without imaging guidance; first lesion
10005+10006 -Fine needle aspiration biopsy, including ultrasound guidance; first lesion
10007+10008 -Fine needle aspiration biopsy, including fluoroscopic guidance; first lesion
10009+10010 -Fine needle aspiration biopsy, including CT guidance; first lesion
10011+10012 -Fine needle aspiration biopsy, including MR guidance; first lesion

Note: When multiple procedures are performed for different patient encounters on the same day, apply the appropriate modifier (-59) to distinguish payment for different encounters, including those involving Medicare patients.

Biopsy Guidance Radiological S & I (eg, biopsy, aspiration, injection, localization device):-

Ultrasonic guidance-76942
Fluoroscopic guidance-+77002
Computed tomography guidance-77012
Magnetic resonance imaging guidance-77021

1. Sample Report:

CT GUID LUNG NEEDLE BIOPSY:-

CLINICAL INDICATION- Right lung nodule.

Interpretation- The procedure and its potential complications were explained to the patient. The patient read and signed an informed consent form. The patient was positioned on his left side in the CT gantry and multiple images of the chest obtained. A puncture site was selected in the mid intercostal spaces in the midaxillary line. The skin marker was placed. A standard procedure pause was obtained at that time. The patient's name, DOB, and the order to perform a CT-guided biopsy of the right lung nodule were verified. All the team members agreed.
The skin was prepped in a usual standard sterile fashion. Superficial and deep local anesthesia was achieved by injecting 7 of 1% lidocaine locally. 100 mcg of fentanyl and 1 mg of Versed were infused intravenously for conscious sedation, which lasted for 15 minutes. The patient was monitored throughout the procedure. A 17-gauge guide was inserted and advanced under CT guidance to the lateral border of the nodule. A core specimen was obtained. The patient had an episode of moderate coughing. The needles were removed. The patients spitted blood clots estimated at about 50 mL. He was placed on his back and a CT of the chest obtained. There is a moderate amount of blood surrounding the nodule in the right lower lobe. There is a moderate-sized right pleural effusion. Numerous nodular and linear densities are seen in both lungs,
more prominent on the left. Pacemaker wires are seen in the heart. No pericardial effusion is noted. 

IMPRESSION-
1. CT guided biopsy of a right lung nodule.
2. The estimated blood loss is about 60 mL.
3. Post-procedure CT demonstrates bleeding around the nodule in the
right lower lobe and a moderate-sized right pleural effusion.


2. Sample Report: 

CT BIOPSY - LIVER

History: Elevated liver enzymes.

Reference: None.

CT guided liver biopsy:

The procedure was explained to the patient with appropriate risks detailed (including pneumothorax, hemorrhage, fistula, bile leak,
among others). Informed written consent was obtained. The right
abdomen was prepped and draped in the proper sterile fashion with 1%
Xylocaine administered for local anesthetic purposes. The liver was localized. Under CT guidance, multiple 18 gauge core biopsies of the liver were performed. The adequate specimen was visualized. Post-biopsy
imaging was unremarkable. The patient was without complaint with regard to the procedure. 

Impression: 

1. CT guided liver biopsy with 4 separate 18-gauge cores obtained and sent to Pathology. 2. No complications encountered.

3. Sample Report:

CT GUID PANCREAS BIOPSY.

HISTORY- Pancreatic mass

PROCEDURE- Informed consent was obtained from the patient for a CT-directed biopsy of pancreatic mass. The patient was placed on the CT table in the supine position and images were obtained through the area of interest. The skin was marked, prepped with Chloroprep, and anesthetized with 2% lidocaine. Using CT, a 20 gauge Chiba needle was advanced into the lesion and a sample obtained for cytology. The second and third samples were obtained in a similar fashion using a 20 gauge Chiba needle. The patient received 2 mg of Versed and 50 mcg of fentanyl intravenously and was monitored throughout the procedure by the radiology nurse with no adverse reaction. Sedation time 25 minutes.

IMPRESSION- Successful CT-directed biopsy of pancreatic mass. No Complications. Results pending.

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