# SVC gram



## prabha (Aug 5, 2010)

My codes for the below procedure are 

36558
36589
36005-5950
75822-26
76937-26.
Do we need to code SVC gram(75827-26) for the below procedure??? 

Procedure in brief: Bilateral upper extremity venogram, removal of
       right internal jugular permacatheter, left external jugular
       permacath placement             

       Angiocaths were placed into arm veins bilaterally. Bilateral upper
       extremity venography was then performed. With the patient in the
       supine position the left upper chest region was prepped and draped
       in the usual sterile fashion. Ultrasound examination demonstrates
       occlusion of the left internal jugular vein. The left external
       jugular vein is patent. The external jugular vein was then
       accessed via posterior approach under real-time ultrasound
       guidance using a 21-gauge micropuncture needle. A 4 French tapered
       dilator was placed via this puncture site. A stiff guidewire was
       then placed extending into the right atrium. The tract was
       sequentially dilated up to 15 French and a peel-away sheath
       placed.

       A site along the more inferolateral aspect of the chest was
       selected and the overlying skin was anesthetized with 1% Xylocaine
       solution. A small transverse incision was made a tract created
       from the incision to the venotomy site using a tunneling device. A
       14 French, 27 cm long Split cath permacath was then advanced along
       this tract, placed through the peel-away sheath and massaged into
       position. The peel-away sheath was then removed. The catheter was
       sutured into place using 2-0 Ethilon sutures. Each catheter port
       was aspirated and primed with heparin. A sterile dressing was then
       applied.

       The right upper chest region and catheter were then prepped and
       draped in usual sterile fashion. After the administration of local
       anesthesia, the subcutaneous cuff was freed using blunt
       dissection.  The indwelling catheter was then withdrawn into the
       right brachiocephalic vein.  A superior venacavogram was performed
       demonstrating narrowing within the brachiocephalic vein with an
       extensive fibrin sheath. The catheter was then removed.
       Compression was applied to the venotomy and skin entry sites until
       adequate hemostasis was achieved.   The site was covered with a
       sterile dressing.  The patient tolerated the procedure without
       incident.

       Findings: Bilateral upper extremity venography demonstrating
       patency of the left cephalic and basilic veins within the upper
       arm. The left axillary, subclavian and brachiocephalic veins are
       patent. The superior vena cava is patent. The right basilic and
       brachial veins in the upper arm are patent. The axillary and
       subclavian veins are occluded. Collateral vessels are identified
       in the supraclavicular region. The brachiocephalic vein is not
       opacified. These findings are consistent with acute or subacute
       thrombus within the axillary vein.

       Superior venacavogram demonstrating extensive fibrin sheath versus
       severe narrowing within the right brachiocephalic vein along the
       course of the catheter.

       Following left external jugular PermCath placement, distal
       catheter tip is identified overlying the proximal right atrium in
       good position.

       Impression:       
       Right upper extremity venogram demonstrating axillo-subclavian
       venous occlusion suspicious for acute versus subacute thrombosis.
       Severe narrowing within the brachiocephalic vein is identified.
       The superior vena cava is patent. The left axillary, subclavian
       and brachiocephalic veins are patent.

       Successful placement of 27 cm, double lumen left external jugular
       permacath with its distal tip extending to the proximal right
       atrium as described above.

       Successful removal of right internal jugular permacath.


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