# Bilateral multi-sidehole infusion catheters



## Shirleybala (May 13, 2009)

Bilateral infusion cathaters are placed in both legs should i need to code 37201 twice, please confirm.

      The patient was placed prone on the angiography table.
      Preliminary ultrasound demonstrated thrombus within the bilateral
      popliteal veins.  The bilateral popliteal regions were prepped and
      draped in the usual sterile manner.  Local anesthesia was achieved
      with 1% lidocaine.  Under real-time ultrasound guidance the
      bilateral popliteal veins were accessed with a micropuncture set.
      A sonographic recording was made for patient's medical record.
      Bilateral 9-French sheaths were placed.

      Findings:

      Contrast was injected demonstrating extensive clot extending from
      the bilateral popliteal veins to the inferior vena cava.  Clots is
      seen extending slightly above the apex of the most inferior
      inferior vena cava filter.

      Intervention:

      Bentson wires were advanced through the sheaths and into the
      inferior vena cava, above the IVC filter.  Mechanical and
      pharmacologic thrombectomy was performed with the Trellis
      catheter.  On the left the catheter was advanced with proximal
      balloon in the inferior vena cava, above the inferior filter.
      Four runs were performed, extending down to the popliteal vein,
      with a total of 14 mg of TPA.  On the right the catheter was
      advanced with the proximal balloon in the right common iliac vein.
      Three runs were performed, extending down to the popliteal vein,
      with a total of 15 mg of TPA.  Repeat contrast injection through
      both sheaths demonstrated slight improvement with significant
      residual thrombus.  An Omni flush catheter was advanced to the
      level of the inferior vena cava, just above the bifurcation.
      Contrast was injected and digital subtraction angiography was
      performed demonstrating improvement, however significant residual
      thrombus within the inferior vena cava and in the inferior IVC
      filter.

      At this point there was a discussion with the neuro- ICU attending
      and Dr.xxx.  Given risks and benefits, it was decided to place
      multi-side hole infusion catheters and infused TPA overnight in
      order to give patient potential for more complete thrombolysis.

      Bilateral Cragg-McNamara infusion catheters, with 50-cm infusion
      length, were advanced.  On the left the catheter extended from the
      apex of the inferior IVC filter to the mid femoral vein.  On the
      right the catheter extended from the right common iliac vein to
      the distal femoral vein, at the level of the distal tibia.
      Occlusion wires were placed through the bilateral catheters.  TPA
      was infused at a concentration of 0.5 mg/hr.  Heparinized saline
      was infused through the bilateral sheath.  The sheaths were
      sutured in place.  Sterile dressings were applied bilaterally.

      Plan is to allow infusion overnight and pull infusion catheters
      and sheaths in 24 hours, in the intensive care unit.


      Impression:

      Bilateral venograms demonstrating extensive thrombus extending
      from the bilateral popliteal veins to the inferior vena cava,
      above the inferior IVC filter.

      Pharmacologic and mechanical thrombectomy performed with the
      Trellis catheter and a total of 29 mg TPA.  Repeat venogram
      demonstrates improvement, however significant residual thrombus
      extending from the bilateral popliteal veins to the inferior vena
      cava.

      Bilateral multi-sidehole infusion catheters placed with 50-cm
      infusion length and occlusion wires.  Infusion of TPA performed at
      0.5 mg/hr.


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## MLS2 (May 13, 2009)

I'm thinking 37187 on the left and 75896/37201 on the right...


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## dhuston (May 13, 2009)

Yes, 37201 x2 since they're separate.

Diane Huston, CPC,RCC


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## MLS2 (May 14, 2009)

yes, you're both correct, 75896/37201x2 and the 37187


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