AHA Coding Clinic® for HCPCS - 2025 Issue 3; Ask the Editor

Percutaneous Hepatic Perfusion With Trans-arterial Administration of Melphalan

The patient presents for the administration of melphalan to the hepatic artery to treat unresectable uveal melanoma metastases. Ultrasound-guided access was achieved through the right internal jugular vein (IJV), right common femoral vein, left IJV, and left common femoral artery. A catheter was positioned into the celiac artery where an angiogram was performed. The superior mesenteric artery was selected, and an angiogram was performed to reveal the right hepatic artery. The right hepatic artery was selected, and an arteriogram was performed. Cone beam CT of the abdomen was performed with contrast injected through the catheter into the right hepatic artery. Numerous areas of tumoral perfusion were demonstrated in the right hepatic lobe.The celiac trunk was re-selected, and an arteriogram was performed on the left hepatic artery. Cone beam CT of the abdomen was performed to reveal the right gastric artery arising from the proximal left hepatic artery. The right gastric artery was embolized with coils. Repeat arteriogram from the left hepatic artery demonstrated evidence of a small supraduodenal arterial artery. It was catheterized and an arteriogram was performed. Coils were used to embolize the supraduodenal artery. There was non-opacification of the right gastric and supraduodenal arteries.A double balloon catheter was inserted into the inferior vena cava (IVC) where a diagnostic cavogram was performed. The balloon catheter was connected to a perfusion circuit. Melphalan was delivered at 230 mL into the left hepatic artery with concurrent withdrawal of fluid via the IVC catheter into the filtration system and return infusion into the right IJV. The superior mesenteric artery was selected to catheterize the right hepatic artery where 270 mL of Melphalan was delivered with concurrent withdrawal of fluid via the IVC catheter into the filtration system and returned into the right IJV.Following the injection of melphalan, washout of the liver with filtration was performed for 30 minutes. The hepatic artery catheters, and IVC balloon catheters were removed and the artery and venotomy sites were closed.Which CPT code(s) are appropriate for this procedure? Would the selective catheterizations and imaging also need to be separately reported? ...

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