# Billing for Discontinued venous port insertion



## kristi9712 (Feb 5, 2013)

Please help.

Provider attempted to access left subclavin vein, multiple times, but discontinued and moved to the right side.  How would you code this?


DOB: 6/XX/1994


PROCEDURE DATE: /2012


PRE-OP DIAGNOSIS: Pre-Op Diagnosis Codes:
   * GASTROPARESIS [536.3]


POST-OP DIAGNOSIS: same


PROCEDURE: VENOUS PORT INSERTION, RIGHT SUBCLAVIAN


ANESTHESIA: General


Surgeon(s):
XXX
XXX

SIGNIFICANT FINDINGS: suggestion of subclavian vein narrowing in left


ESTIMATED BLOOD LOSS: 10  mL(s)      

SPECIMEN TAKEN:No


Consent:  Informed consent was obtained after detailed discussion of the indications, planned procedure, alternatives and risks.


Description of Operation/Procedure:  After induction of satisfactory general anesthesia and with the patient in Trendelenburg position, the chest was prepped and draped in sterile fashion.  We excised the old left upper chest scar and attempted multiple times to access the left subclavian vein, but were unable to advance a wire. There was suggestion of stenosis or obstruction. The wound was then closed in two layers and sealed with Dermabond.


The right subclavian vein was then accessed percutaneously and a wire passed into the superior vena cava under fluoroscopic guidance.  After pre-injection with Marcaine, a port-pocket was created on the right superior chest wall.  A previously flushed 6.6 French low-profile Mediport fit nicely in the pocket and was secured with 2 PDS sutures.  The silastic catheter was trimmed to size and advanced into the superior vena cava using an introducer and the Seldinger technique under fluoroscopic guidance.  The catheter aspirated and flushed easily.  The tip of the catheter rested at the cavoatrial junction and there was no evidence of hemo- or pneumothorax.  The Mediport pocket incision was closed in two layers and covered with Dermabond and the catheter flushed with 100 units/mL heparin.


The patient tolerated the procedure well and was awakened in anticipation of extubation and transfer to the recovery room.  


I was present throughout the case.


Electronically signed by:


I want to code:
36561
36561-53
77001-26


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## geiser35 (Feb 15, 2013)

I agree with the just one 36561-53 and the fluoroscopy since sedation was started and the procedure had to be aborted.


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## cbing (Feb 19, 2013)

I would not code 36561-53 for the left subclavian.  CPT guidelines instruct us that when there is a CPT code that describes the work performed, code for what was done, not what was intended.  In this case, they were not even able to access the vein, let alone begin placing the catheter.  At best you might be able to code 36410-52 "Venipuncture, age 3 years or older, mecessitating the skill of a physician or other qualified health care professional, for diagnostic or therapeutic purposes."

Regarding the modifier, -53 modifier is typically used when the procedure is aborted due to "extenuating circumstances or those that threaten the well being of the patient."  It is questionable whether or not this would qualify as "extenuating circumstances."  I would suggest using the -52 modifier for "reduced services."

Corinna Bing, CPC, RCC, CIRCC


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