# Cv Catheter Inject/check, Tip



## Shirleybala (Sep 11, 2008)

Hi,
 can i use these for the below report please suggest me
CPT	
36597				
36598	

CV CATHETER INJECT/CHECK, TIP  
     Patient is a 63-year-old woman with history of breast cancer
      status post placement of right IJ chest wall port on 7/20/08.
      Infusion therapy unable to access port.  Request for evaluation

      Procedure:

      The risks, benefits and alternatives to the procedure were
      explained to the patient.  The patient's son was present during
      the consent process.  The patient agreed and signed informed
      consent.  The patient was placed on the angiography table in the
      supine position.  Fluoroscopic evaluation of the chest revealed
      the port reservoir to be malpositioned and flipped.  Catheter tip
      is seen overlying the superior vena cava with catheter extending
      high into the right internal jugular vein.  Utilizing manual
      manipulation the port was repositioned appropriately in the
      upright position.  During this maneuver however the catheter
      component became  looped within the subcutaneous tissues.
      Additional manipulations was performed with an loop largely being
      corrected but residual curved noted in the subcutaneous tissues.
      Catheter remained  high into the internal jugular vein with tip
      overlying the superior vena cava.  The reservoir was then accessed
      using sterile technique.  There was only poor aspiration of blood
      however instillation of contrast material demonstrated wide
      patency of the port reservoir and catheter with flow of contrast
     seen into the superior vena cava and right atrium.  There was no
      extravasation of contrast material.  It was decided to discontinue
      additional manipulations at this time.  The port reservoir was
      left accessed for infusion therapy.  The infusion therapy
      department was contacted regarding the results of this procedure.

      Impression:

      Patient presented with malpositioning of port reservoir.  Port
      reservoir was readjusted into appropriate upright position.
      During this maneuver however catheter portion of the port became
      somewhat coiled in the subcutaneous tissues.  Port patency however
      was maintained with tip over the superior vena cava.

      Plan: Patient to have chemotherapy today.  Patient to return in
      one week for chemotherapy.  If continued difficulty with
      aspiration of blood remains attempts at repositioning  catheter
      may be warranted.  If this fails to resolve the problem placement
      of alternate port via the left IJ may


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## lavanyamohan (Sep 11, 2008)

Reply:
The catheter has flipped. There is lot of maneuvering. So, can give insertion codes, afresh.


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## MLS2 (Sep 11, 2008)

36597, 36598-51 look correct to me.  The catheter wasn't removed and replaced, just moved around and then injected.


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