# 3 access



## Shirleybala (May 28, 2009)

Hello plz confirm these codes work on below documentation
36556
36011
36011-59
76937-26
76937-2659
76937-2659 
     Procedure: Non-tunneled hemodialysis catheter placement, left
      common femoral vein sheath, left internal jugular vein sheath

      Initially the procedure was discussed with the patient including
      risks, benefits and alternatives.  Risks discussed included but
      were not limited to bleeding, infection, venous thrombosis and
      occlusion.  The patient appeared to understand, asked appropriate
      questions \T\ signed informed consent.  0.5  Minutes fluoroscopy
      time.  The patient received IV Versed and fentanyl for conscious
      sedation and analgesia, administered and monitored by the
      interventional radiology nurse.

      Preliminary ultrasound of the right groin, left groin and left
      internal jugular vein demonstrates patency of the right femoral  
      vein, left femoral vein and left internal jugular vein.  The
      bilateral groins and left neck were then prepped and draped in the
      usual sterile manner and locally anesthetized with one percent
      lidocaine.  Under real-time ultrasound guidance, the right femoral
      vein was accessed with a micropuncture set.  A sonographic
      recording was made for patient's medical record.  An Amplatz wire
      was then advanced into the inferior vena cava.  The tract was then
      dilated, and a 14 Fr 24 cm long Schon XL vascath was placed,
      catheter tips in the inferior vena cava.  Good bidirectional flow
      was noted from both lumens, which were locked with heparin
      solution.  The catheter was sutured in place with 2-0 prolene and
      a sterile dressing applied.

      Under real-time ultrasound guidance, the left femoral vein was
      accessed with a micropuncture set.  A sonographic recording was
      made for patient's medical record.  An Amplatz wire was advanced
      into the inferior vena cava.  The tract was then dilated, and an
      8-French sheath was placed.  The tip of the sheath is in the left
      iliac vein.  The sheath was flushed with saline.  A sterile
      dressing was then applied.

      Under real-time ultrasound guidance, the right internal jugular
      vein was accessed with a micropuncture set.  A sonographic
      recording was made for patient's medical record.  An Amplatz wire
      was advanced, the tract was dilated and a 5-French sheath was
      placed.  The tip of the sheath is in the left brachiocephalic
      vein.  The sheath was flushed with saline.  The sheath was secured
      to the skin with 2-0 Prolene a sterile dressing applied.

      The patient tolerated the procedure well, left the department in
      stable condition.  No immediate complications.

      Impression:

      SUCCESSFUL PLACEMENT OF RIGHT FEMORAL 24 CM LONG  
      SCHON XL VASCATH, CATHETER TIP IN INFERIOR VENA CAVA.

      SUCCESSFUL PLACEMENT OF 8 FRENCH SHEATH IN LEFT FEMORAL VEIN WITH
      TIP IN LEFT ILIAC VEIN.

      SUCCESSFUL PLACEMENT OF 5 FRENCH SHEATH IN LEFT INTERNAL JUGULAR
      VEIN WITH TIP IN BRACHIOCEPHALIC VEIN.


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## MLS2 (May 28, 2009)

sounds like 3 central lines...it'll depend on what they're (sheaths) are being used for...


"If they are used as central lines (which they frequently are) then they should be considered as such. 
If they are used as portals for other catheters (such as a Swan) then unfortunately they are not considered central lines."  (per a physician I work for)


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## dpeoples (May 29, 2009)

Shirleybala said:


> Hello plz confirm these codes work on below documentation
> 36556
> 36011
> 36011-59
> ...




Well, I do wonder what the sheath's are for? Without more clarity here is how I would code:

36556
36000-59 (sheaths and catheters are not neccesarily the same thing)
36000-59
77001
76937 (this code description says potential access site(s)--plural, so I would only code once per session.

I hope this helps.


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## MLS2 (Jun 2, 2009)

I concur


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## Shirleybala (Jun 3, 2009)

Thankyou,


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