# Insertion of right femoral vein triple lumen venous catheter.



## melissalynnfalkowski (May 29, 2012)

PRE-OP DIAGNOSIS:        Cardiogenic shock.

POST-OP DIAGNOSIS:        Same.

OPERATION:               Insertion of right femoral vein triple lumen venous catheter.

SURGEON:           ASSISTANT:

INDICATIONS: Patient in cardiogenic shock requiring intubation and constant monitoring of blood pressure and invasive central venous access for intravenous vasopressor support.

PROCEDURE/FINDINGS: Above mentioned patient is a request from Dr.  of cardiology for central venous access in this patient requiring intravenous vasopressors for support of her hemodynamics and her cardiogenic shock status. I discussed the case with Dr.  who is also the patient's son and Health Care Proxy and he both agrees with the plan for central venous access and gives consent to proceed.

The patient's right femoral/groin region was prepped with antiseptic solution and standard sterile draping was applied. Strict aseptic technique was utilized throughout the procedure. After 5 mL of 1% local lidocaine was infused over right femoral vein site, a large bore needle was used to gain access to that right femoral vein and dark nonpulsatile venous aspirate was obtained. A guidewire was passed through the large bore needle into the right femoral vein and advanced. The large bore needle was then withdrawn. The guidewire tract was then dilated and then a triple lumen venous catheter was inserted over the guidewire and advanced into the right femoral vein. The guidewire was then withdrawn. All three ports on the triple lumen catheter were then aspirated for dark nonpulsatile venous aspirate. All three ports were then flushed clear with sterile normal saline. The triple lumen catheter was then suture secured at multiple sites to the skin. At the end of the procedure an occlusive dry sterile dressing was applied over the catheter at the insertion site. The patient tolerated the procedure well.


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## MLS2 (Jun 5, 2012)

sounds like 36556


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## Grintwig (Jun 5, 2012)

In order for this to be coded as a central venous access device the catheter tip must be documented as being advanced into the iliac vein. I do not see that in this operative note.
I would use 36569.


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## dpumford (Jun 6, 2012)

I believe this would be a 36556.. I copied a pasted a blog from this forum that may help with deciding...Also 36556 is done in the Or where Picc lines can be done at bedside are done in the arm.

I hope this helps..


_Originally Posted by 
I meant 36569....Why not 36569 since it's peripherally inserted? 

Found under the heading of Central Venous Access Procedures in the CPT book you will see descriptions of what constitutes centrally inserted vs peripherally inserted. 

Central (jugular, subclavian, femoral vein or IVC)
Peripheral (basilic or cephalic vein)

HTH  
__________________
CIRCC,CPC _


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