# Tunneled cath exchange



## stgregor

Hello,

Maybe I am reading too much into this report as it seems there's a lot of info for just a simple tunneled CV cath replacement. It's been a while since I've coded one, but I recall the ballooning of the subcutaneous tract was included in the change. I coded this as 36581, 77001. Thoughts? Thanks!

PROCEDURE: REPLACEMENT TUNNELED CV CATH
INDICATION: Patient with non-functioning Permcath. The patient
states the Permcath was placed approximately 5 years ago. Upon
inspection, the cuff is out of the skin.

PROCEDURE PERFORMED:
1. Removal of a tunnel dialysis catheter over a wire.
2. Superior vena cava venogram.
3. Balloon angioplasty of the catheter entry site at the right
internal jugular vein.
4. Placement of a new 23-cm, tip-to-cuff, tunnel dialysis line with a
Dacron cuff.
5. IV conscious sedation.

PROCEDURE DESCRIPTION
Preprocedure evaluation confirmed that the patient was an appropriate
candidate for conscious sedation. Vital signs, pulse oximetry, and
response to verbal commands were monitored and recorded by the nurse
throughout the procedure and the recovery period. All medications for
conscious sedation including the dose administered were placed in the
medical record. The patient returned to baseline neurologic and
physiologic status prior to leaving the department. No immediate
sedation-related complications were noted.
Informed written consent was obtained from the patient after
discussion of the risks, benefits, and alternatives to the procedure.
The patient expressed full understanding and agreed to proceed
forward.
The patient was placed supine on the angiographic table. The exiting
catheter and right chest were prepped and draped in normal sterile
fashion. Two stiff glidewires were advanced through the lumen of the
catheter into the inferior vena cava after the heparin had been
withdrawn. The catheter was removed without difficulty. A new 19-cm,
tip-to-cuff catheter was inserted. The tip of the line is within the
superior vena cava. The tube would not aspirate or flush, therefore
the tube was removed over the stiff glidewires. A 23-cm, tip-to-cuff
catheter was then inserted. The catheter had difficulty advancing.
With the catheter in the superior vena cava, injection of contrast
was performed to evaluate for stenosis. The superior vena cava is
widely patent. The catheter was then attempted to be re-advanced
without success. Following, the catheter was withdrawn and balloon
angioplasty was performed throughout the subcutaneous tract as well
as the venotomy site with a 4 mm balloon. The catheter was then
re-advanced without success. Following, with the catheter in the
superior vena cava, the wire was withdrawn and 2 stiff Amplatz wires
were then advanced into the inferior vena cava. Eventually, the
catheter was then placed with tip in the right atrium. The line is
intact without evidence of disconnect or kink. The line flushes and
aspirates appropriately.
The line was secured to the skin using 2-0 prolene suture. The line
was blocked with heparin per the manufacturer's protocol.
The patient received 1 g Ancef and 50 mcg fentanyl IV during the
procedure. A total of 20 mL of contrast was injected into the
superior vena cava.

CONCLUSION
1. Successful exchange of a dual-lumen dialysis catheter with a
Dacron cuff. A 23-cm, tip-to-cuff, 15.5-French, dual-lumen catheter
was placed with tip in the right atrium. The line flushes and
aspirates appropriately.
2. Superior vena cavogram was performed demonstrating a widely patent superior vena cava.


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## stgregor

Anyone have any ideas on this one? Thanks!


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## dpeoples

stgregor said:


> Hello,
> 
> Maybe I am reading too much into this report as it seems there's a lot of info for just a simple tunneled CV cath replacement. It's been a while since I've coded one, but I recall the ballooning of the subcutaneous tract was included in the change. I coded this as 36581, 77001. Thoughts? Thanks!
> 
> PROCEDURE: REPLACEMENT TUNNELED CV CATH
> INDICATION: Patient with non-functioning Permcath. The patient
> states the Permcath was placed approximately 5 years ago. Upon
> inspection, the cuff is out of the skin.
> 
> PROCEDURE PERFORMED:
> 1. Removal of a tunnel dialysis catheter over a wire.
> 2. Superior vena cava venogram.
> 3. Balloon angioplasty of the catheter entry site at the right
> internal jugular vein.
> 4. Placement of a new 23-cm, tip-to-cuff, tunnel dialysis line with a
> Dacron cuff.
> 5. IV conscious sedation.
> 
> PROCEDURE DESCRIPTION
> Preprocedure evaluation confirmed that the patient was an appropriate
> candidate for conscious sedation. Vital signs, pulse oximetry, and
> response to verbal commands were monitored and recorded by the nurse
> throughout the procedure and the recovery period. All medications for
> conscious sedation including the dose administered were placed in the
> medical record. The patient returned to baseline neurologic and
> physiologic status prior to leaving the department. No immediate
> sedation-related complications were noted.
> Informed written consent was obtained from the patient after
> discussion of the risks, benefits, and alternatives to the procedure.
> The patient expressed full understanding and agreed to proceed
> forward.
> The patient was placed supine on the angiographic table. The exiting
> catheter and right chest were prepped and draped in normal sterile
> fashion. Two stiff glidewires were advanced through the lumen of the
> catheter into the inferior vena cava after the heparin had been
> withdrawn. The catheter was removed without difficulty. A new 19-cm,
> tip-to-cuff catheter was inserted. The tip of the line is within the
> superior vena cava. The tube would not aspirate or flush, therefore
> the tube was removed over the stiff glidewires. A 23-cm, tip-to-cuff
> catheter was then inserted. The catheter had difficulty advancing.
> With the catheter in the superior vena cava, injection of contrast
> was performed to evaluate for stenosis. The superior vena cava is
> widely patent. The catheter was then attempted to be re-advanced
> without success. Following, the catheter was withdrawn and balloon
> angioplasty was performed throughout the subcutaneous tract as well
> as the venotomy site with a 4 mm balloon. The catheter was then
> re-advanced without success. Following, with the catheter in the
> superior vena cava, the wire was withdrawn and 2 stiff Amplatz wires
> were then advanced into the inferior vena cava. Eventually, the
> catheter was then placed with tip in the right atrium. The line is
> intact without evidence of disconnect or kink. The line flushes and
> aspirates appropriately.
> The line was secured to the skin using 2-0 prolene suture. The line
> was blocked with heparin per the manufacturer's protocol.
> The patient received 1 g Ancef and 50 mcg fentanyl IV during the
> procedure. A total of 20 mL of contrast was injected into the
> superior vena cava.
> 
> CONCLUSION
> 1. Successful exchange of a dual-lumen dialysis catheter with a
> Dacron cuff. A 23-cm, tip-to-cuff, 15.5-French, dual-lumen catheter
> was placed with tip in the right atrium. The line flushes and
> aspirates appropriately.
> 2. Superior vena cavogram was performed demonstrating a widely patent superior vena cava.



I agree with your code selection.
HTH


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## kudukalarahul@gmail.com

*Your codes r right, angioplasty performed for the tract purpose is not billed separte*



stgregor said:


> Hello,
> 
> Maybe I am reading too much into this report as it seems there's a lot of info for just a simple tunneled CV cath replacement. It's been a while since I've coded one, but I recall the ballooning of the subcutaneous tract was included in the change. I coded this as 36581, 77001. Thoughts? Thanks!
> 
> PROCEDURE: REPLACEMENT TUNNELED CV CATH
> INDICATION: Patient with non-functioning Permcath. The patient
> states the Permcath was placed approximately 5 years ago. Upon
> inspection, the cuff is out of the skin.
> 
> PROCEDURE PERFORMED:
> 1. Removal of a tunnel dialysis catheter over a wire.
> 2. Superior vena cava venogram.
> 3. Balloon angioplasty of the catheter entry site at the right
> internal jugular vein.
> 4. Placement of a new 23-cm, tip-to-cuff, tunnel dialysis line with a
> Dacron cuff.
> 5. IV conscious sedation.
> 
> PROCEDURE DESCRIPTION
> Preprocedure evaluation confirmed that the patient was an appropriate
> candidate for conscious sedation. Vital signs, pulse oximetry, and
> response to verbal commands were monitored and recorded by the nurse
> throughout the procedure and the recovery period. All medications for
> conscious sedation including the dose administered were placed in the
> medical record. The patient returned to baseline neurologic and
> physiologic status prior to leaving the department. No immediate
> sedation-related complications were noted.
> Informed written consent was obtained from the patient after
> discussion of the risks, benefits, and alternatives to the procedure.
> The patient expressed full understanding and agreed to proceed
> forward.
> The patient was placed supine on the angiographic table. The exiting
> catheter and right chest were prepped and draped in normal sterile
> fashion. Two stiff glidewires were advanced through the lumen of the
> catheter into the inferior vena cava after the heparin had been
> withdrawn. The catheter was removed without difficulty. A new 19-cm,
> tip-to-cuff catheter was inserted. The tip of the line is within the
> superior vena cava. The tube would not aspirate or flush, therefore
> the tube was removed over the stiff glidewires. A 23-cm, tip-to-cuff
> catheter was then inserted. The catheter had difficulty advancing.
> With the catheter in the superior vena cava, injection of contrast
> was performed to evaluate for stenosis. The superior vena cava is
> widely patent. The catheter was then attempted to be re-advanced
> without success. Following, the catheter was withdrawn and balloon
> angioplasty was performed throughout the subcutaneous tract as well
> as the venotomy site with a 4 mm balloon. The catheter was then
> re-advanced without success. Following, with the catheter in the
> superior vena cava, the wire was withdrawn and 2 stiff Amplatz wires
> were then advanced into the inferior vena cava. Eventually, the
> catheter was then placed with tip in the right atrium. The line is
> intact without evidence of disconnect or kink. The line flushes and
> aspirates appropriately.
> The line was secured to the skin using 2-0 prolene suture. The line
> was blocked with heparin per the manufacturer's protocol.
> The patient received 1 g Ancef and 50 mcg fentanyl IV during the
> procedure. A total of 20 mL of contrast was injected into the
> superior vena cava.
> 
> CONCLUSION
> 1. Successful exchange of a dual-lumen dialysis catheter with a
> Dacron cuff. A 23-cm, tip-to-cuff, 15.5-French, dual-lumen catheter
> was placed with tip in the right atrium. The line flushes and
> aspirates appropriately.
> 2. Superior vena cavogram was performed demonstrating a widely patent superior vena cava.




Your codes r right, angioplasty performed for the tract purpose is not billed separately!


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## twizzle

This thread is from 2011. I think the claim will have been submitted by now.
It is worth looking at the dates in these threads.


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