# help w/removal/replacement catheter



## BABS37 (Jan 9, 2012)

I have a question on this patient chart and how to code it. I did 36589, 36581, 77001 with DX of 996.1. Is this right? Or do I code 36558 with 77001 bc of the 2nd chest incision/site?? I know if it's a device- port or pump, you can bill for both removal and replacement but what about the catheter? The guidelines say "use the code describing the service with a frequency of two"- I have not a clue what that means. ( I apologize for the report- they use the speech recognition so it doesn't always make sense...)

Procedure: Removal and Placement of new right internal jugular hemodialysis catheter. 

... the catheter and right chest were prepped and draped...skin overlying the felt cuff on the indwelling catheter was incised...the cuff was dissected out freeing the catheter. skin was incised at the internal jugular insertion port. The catheter was transected proximal to the cuff and the distal end of the catheter was removed. The catheter end was brought out through the IJ insertion site skin incision and intubated with .035 guidewire. Guidewire was passed under fluoroscopy into the inferior vena cava and the remaining catheter segment was removed. Counter incision was made on the chest and a 2nd counter incision was made in the supraclavicular fossa. A tunneled hemodialysis catheter was subcutaneously tunneled up through the counter incisions till the wire insertion site. The dilator and sheath were inserted over the wire. The wire and dilator were removed. The catheter tip was inserted through peel away sheath and positioned over at the SVC atrial junction as the peel away sheath was removed. The catheter was flushed...and incisions were closed...


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## BABS37 (Jan 10, 2012)




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