CPT® Code 38200

The injection procedure for splenoportography, designated by CPT® Code 38200, is a specialized diagnostic technique used to visualize the splenic vasculature and its connection to the portal vein. This procedure involves several critical steps that ensure accurate imaging and assessment of the spleen's blood supply. Initially, the skin over the abdomen is thoroughly cleansed to minimize the risk of infection, and a local anesthetic is administered to numb the area overlying the spleen, allowing for a more comfortable experience for the patient. Following this, a sheathed needle is carefully inserted into the spleen under fluoroscopic guidance, which provides real-time imaging to assist the physician in navigating the needle accurately. The needle is advanced along the long axis of the spleen towards the splenic hilum, which is the area where blood vessels enter and exit the spleen. Once the needle is positioned correctly, it is removed, and the presence of free blood return is checked to confirm that the sheath is in the appropriate location. This is a crucial step as it verifies that the needle has accessed the splenic circulation. Subsequently, splenic pulp pressure is measured using a manometer, providing important information about the hemodynamics of the spleen. A small amount of contrast material is then injected to ensure that the sheath is correctly placed, followed by a more substantial injection of contrast media into the spleen. This contrast is essential for visualizing the splenic veins as it drains into the portal vein, allowing for detailed imaging through cineangiography. Additionally, separate radiographs of the splenic vasculature and the portal vein are obtained to provide further diagnostic information. After the completion of the injection procedure, compressed Gelfoam plugs are inserted through the sheath to tamponade the needle tract, which helps prevent bleeding. Finally, the sheath is removed, and a dressing is applied to the site, concluding the procedure. This comprehensive approach ensures that the splenoportography is performed safely and effectively, yielding valuable insights into the vascular anatomy of the spleen and its relationship with the portal circulation.