# central venogram w balloon angioplasty of SVC



## AgnieszkaMarek (Nov 24, 2020)

I am only asking for opinion for procedure 1.
I think *36010,75827, 37248 *?

     EXAM:
     1. Central venogram with balloon angioplasty of the SVC
     2. Removal of left-sided portacatheter
     3. Implant of new right-sided portacatheter

     HISTORY: SVC syndrome
     Intravenous conscious sedation was administered by a dedicated
     independent observer with continuous hemodynamic and respiratory
     monitoring performed, including the use of pulse oximetry.

     FINDINGS/TECHNIQUE:

     Signed informed consent was obtained from the patient.   A time out
     procedure was performed.

     The patient was placed in the supine  position on the stretcher and
     the lateral neck and chest extremity prepped and draped in standard
     sterile fashion.   All elements of maximal sterile barrier technique
     were followed including cap and mask, sterile gown, sterile gloves,
     large sterile sheet, hand hygiene and 2% chlorhexidine for cutaneous
     antisepsis.

    Ultrasound of the right neck demonstrated widely patent internal
     jugular vein. The skin overlying the targeted entry site was
     anesthetized with 10 cc of 1% lidocaine. Using a micropuncture needle
     and microcatheter the internal jugular vein was accessed with
     fluoroscopic guidance confirming venous access. Contrast injection
     through the microcatheter demonstrated occlusion of the SVC with
     dilatation and varicosity of the azygos. The inner dilator of the
     micropuncture sheath was removed and an 035 Glidewire was advanced to
     the IVC.

     The micropuncture sheath was exchanged for an 8 French vascular
     sheath.  The stenotic SVC was angioplastied with a 12 mm x 60 mm
     Mustang balloon followed by a 16 x 16 mm Atlas balloon. Follow-up
     venography demonstrated significant improvement in the stenosis with
     flow no longer seen within the azygos.

     Next, attention was turned to making a subcutaneous pocket for new
     port insertion on the right. Approximately 3 fingerbreadths below the
     midclavicular line a region was infiltrated with 10 cc 1% lidocaine.
     An approximately 3 cm incision was made and the pocket was created
     using blunt dissection.

     Next, the port was assembled and placed into the pocket confirming
     adequate sizing. The tunnel tract was anesthetized with 1% lidocaine
     and the line was tunneled from the pocket to the venotomy site. The
     catheter was measured and cut to the appropriate length. The peel-away
     sheath was placed over the 035 wire at the venotomy site under
     fluoroscopic guidance. The catheter was placed into the peel-away
     sheath and its final position confirmed a single spot image
     documenting the tip within the cavoatrial junction.

     The catheter was flushed terminally with heparin solution per
     protocol.

     The subcutaneous pocket was flushed with bacitracin solution. The
     pocket was closed with deep 3-0 Vicryl sutures and interrupted
     subcutaneous 4-0 Vicryl sutures.  Steri-Strips were applied and a
     sterile dressing was placed.  Steri-Strips were used to close the
     venotomy site.

    Next, attention was turned to removing the left-sided portacatheter.
     The existing portacatheter incision site over the chest was prepped
     and draped in standard sterile fashion.  All elements of maximal
     sterile barrier technique were followed including cap and mask,
     sterile gown, sterile gloves, large sterile sheet, hand hygiene and 2%
     chlorhexidine for cutaneous antisepsis.

     The existing incision area was infiltrated with 1% lidocaine. An
     incision was made, the catheter dissected and removed in entirety.
     Next, the port housing was removed in entirety after blunt dissection.

     The pocket was closed with deep and superficial interrupted sutures.
     Steri-Strips and sterile dressing were applied.

     The patient tolerated the procedure well without immediate
     complication and left the radiology department in stable condition


     IMPRESSION:

     1.  Central/SVC venogram of the stranding chronic occlusion of the SVC
     in the midportion immediately adjacent to left sided portacatheter. 
36010,75827, 37248  ?

     2.  Successful angioplasty of the SVC.

     3. Removal of left-sided portacatheter.


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## such78 (Nov 25, 2020)

I will only code the angioplasty.
1. venography performed of vessels through same access (port a cath insertion) is bundled into 77001.
2. If performed via separate venous access and separately interpreted, 75820, 75822, 75825, and/or 75827 can be codable.


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## Jim Pawloski (Nov 30, 2020)

I would code for this procedure 36561 for the port insertion, 76937 for the ultrasound, 77001 for the fluoro, 37248 for the angioplasty, 36590-59 for the port removal.
HTH,
Jim Pawloski, CIRCC


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## AgnieszkaMarek (Dec 4, 2020)

Jim Pawloski said:


> I would code for this procedure 36561 for the port insertion, 76937 for the ultrasound, 77001 for the fluoro, 37248 for the angioplasty, 36590-59 for the port removal.
> HTH,
> Jim Pawloski, CIRCC


Hi Jim,
thank you for your answer- that's exactly what I coded


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## fami (Jan 17, 2021)

Jim Pawloski said:


> I would code for this procedure 36561 for the port insertion, 76937 for the ultrasound, 77001 for the fluoro, 37248 for the angioplasty, 36590-59 for the port removal.
> HTH,
> Jim Pawloski, CIRCC


HI Jim,
I am planning to take CIRCC exam, may I contact you if have questions/ need advise?

*Fami Sharif-Pour*_, B.S-HIA, RHIT, COC, CPC_


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## Jim Pawloski (Jan 18, 2021)

Sure, go ahead and ask.


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## fami (Jan 28, 2021)

Thanks, 
 Will do.


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## fami (Dec 14, 2021)

Jim Pawloski said:


> Sure, go ahead and ask.


HI Jim,
I finally put my stuff together,  taking exam on Saturday. 
Not understanding dr. Z respond to the question:
q 11; what codes would be reported for selectively catheterizing and imaging r l1-l3 lumbar? 

tx


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## khemchand (Dec 15, 2021)

36245*3,75705*3


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## Jim Pawloski (Dec 15, 2021)

You may see it as 36245, 36245-59, 36245-59. S&I would be 75705.
Good Luck,
Jim


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## fami (Dec 16, 2021)

HI  Jim, Thanks for the respond. 
why 36245 x3? i do not get that part.


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## such78 (Dec 16, 2021)

fami said:


> HI  Jim, Thanks for the respond.
> why 36245 x3? i do not get that part.


L1, L2, and L3 
if bilateral, if you need report 2 times on catheterization and imaging. 
e.g., bilateral L1 cath with angiogram, 36245 , 36245 -59, 75705, 75705


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## Jim Pawloski (Dec 17, 2021)

Yes, it could be done that way. Another way for bilateral L1,L2, and L3 could be 36245, 36245 x 5 and 75705, 75705-59 x 5. In reality, the method depends on the insurance company and how they want it. I wanted to show you how the exam may present the codes.
Thanks such78 for your assistance fami's question.

Jim


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## fami (Dec 17, 2021)

Thanks for the respond. 

If bilateral, then L1-L2 should be TWO UNITES of 36245 x2 ; 75705-59 x2

If just unilateral service provided  L1- L2, 36245 & 75705; L2 -L3, 36245, 75705-59.
Am I right?

Fami


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## Jim Pawloski (Dec 19, 2021)

L1 left is 36245 and 75705. L1 right is 36245-59 and 75705-59. L2 left is 36245-59 and 75705-59. L2 right is 36245-59 and 75705-59, and so on. Don't confuse it with how we talk about spinal discs (L1-2).

Jim


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