# right brachial artery was inadvertently punctured,



## Shirleybala (Jan 22, 2009)

Hi 
How to code this report, my codes are   
36120	
36569	
77001	26
76937	26


  Procedure:  Informed consent was obtained prior to the procedure.
      Risks discussed included but were not limited to bleeding,
      infection, venous thrombosis etc...   A preliminary ultrasound
      scan of the right upper arm was performed demonstrating patent
      brachial and basilic veins.  With the patient in the supine
      position the right upper arm was prepped and draped in a sterile
      fashion and the skin and subcutaneous tissues were infiltrated
      with local Lidocaine.  Under real-time sonographic guidance, the
      right brachial artery was inadvertently punctured, and over a
      wire, a 4.5-French peel-away sheath was placed.  Under
      fluoroscopic guidance, evaluation of the wire demonstrates an
      arterial location.  Subsequently, the 4.5-French peel-away sheath
      was removed.  Hemostasis was achieved after 30 minutes of manual
      compression to the brachial artery.  Follow-up sonographic
      evaluation demonstrates a patent artery without evidence of
      periarterial hematoma.

      Subsequently,  under real time ultrasound guidance, the right
      basilic vein was punctured with a 21 gauge needle.  A permanent
      recording was created for the patient's record.  A  0.018 inch
      guidewire was inserted through the needle which was exchanged for
      a 4.5 French peel-away sheath.  A 4 French single lumen Power PICC
      catheter was then cut to 41 cm length and inserted through the  
      peel-away sheath and advanced to the chest.  The catheter tip was
      positioned at the junction of the superior vena cava and right
      atrium.  The peel-away sheath was removed.  The catheter was
      flushed with Heplock solution and secured to the skin with 2-0
      prolene sutures.  A sterile dressing was applied.

      The patient tolerated the procedure well.  Total fluoroscopy time
      was 0.7 minutes.  No intravenous contrast material was utilized.

      Impression:
      Inadvertent puncture of the right brachial artery with placement
      of a 4.5-French peel-away sheath.  The sheath was withdrawn, and
      hemostasis achieved with manual compression.  The patient's right
      arm was immobilized for 6 hours after PICC line insertion.

      Ultrasound and fluoroscopy guided placement of a 4 French 41 cm
      long single lumen Bard Power PICC catheter inserted through the
      right basilic vein without complication.


----------



## MLS2 (Jan 22, 2009)

you'll probably get different answers on this one, but I don't think I would bill for that arterial puncture...It doesn't sound like they "meant" to do that.  There was no medical necessity to puncture the artery. I do agree with your other codes.


----------



## dpeoples (Jan 22, 2009)

You should not bill for the inadvertant arterial puncture. 1) it was not intented and 2) there is no medical neccessity.


----------

