adrianne84
New
Do I need to use 33999 for this procedure? If so, what CPT would I compare it to for fee purposes?
Also, would the catheterizations be coded as 36012? I was considering 37187 but I don't think that would describe this cardiac procedure.
Procedures performed: Percutaneous catheter-based extraction of tricuspid valve vegetations (AngioVAC Procedure) with AngioVac 3 device, Ultrasound-guided vascular access, Placement of Gore 26-Fr. DrySeal sheath into right internal jugular vein, Placement of Fem-flex 18-Fr. cannula into right femoral vein, Fluoroscopy, TEE interpretation, Initiation and management of venovenous bypass circuit.
Operation Details: After appropriate informed consent was obtained, the patient was brought to the hybrid OR and placed in supine position on the OR table. He was intubated and placed under general endotracheal anesthesia. Standard monitoring lines and a TEE probe were placed. I interpreted the TEE as showing severe tricuspid regurgitation, native tricuspid valve endocarditis with a large > 1 cm vegetation involving the anterior leaflet of the tricuspid valve and preserved/hyperdynamic ventricular function. Following sterile prep and drape, i used ultrasound guidance to access the right femoral vein. Then, an Amplatz super stiff wire was advanced into the IVC under TEE and fluoroscopic guidance. The patient was then heparinized for the AngioVAC procedure. The access site was serially dilated, and then, a 18-Fr. Fem-flex cannula was advanced into the right femoral vein. The cannula was flushed with heparinized saline. Then, an Amplatz super stiff wire was advanced via the indwelling right IJ sheath and the sheath removed. The access site was dilated, and ultimately, a 26-Fr. GoreDrySeal sheath was placed under TEE and fluoroscopic guidance. The femoral venous sheath and the AngioVac 3 device were then connected, using wet-to-wet connections to the venovenous bypass circuit. Next, the AngioVac 3 device was brought into the right IJ sheath, and venovenous bypass initiated up to a flow rate of 3 L/minute without cavitation. The oversleeve was withdrawn to expose the AngioVac 3 device in the right atrium, and it was positioned towards the tricuspid valve under 3D TEE guidance. Then, using multiple passes with the AngioVac 3 device over the anterior leaflet vegetations, i was able to remove all Surgery Date and Time: 01/22/2021 0800 Primary Procedure: ANGIOVAC Secondary Procedure: TRANSESOPHAGEAL ECHOCARDIOGRAM mobile vegetation components from the tricuspid valve leaflets. 3D TEE showed, as expected, persistent severe TR, and leaflet flail, as well as some ventricular components of infection adherent to the papillary muscles. Once we had achieved complete debulking of the tricuspid valve leaflets, the AngioVac 3 device was withdrawn into the sheath, the venovenous bypass circuit was then interrupted and the trap inspected. There were copious amounts of vegetations noted in the trap. The venous blood was withdrawn to cell saver, processed and returned to the patient. The IJ and femoral sheaths were withdrawn and a single figure-of-8 suture placed at each location and manual compression was used for hemostasis. The heparin effect was reversed with protamine. The patient was extubated in the hybrid OR, and transferred to the PACU in stable condition.
Also, would the catheterizations be coded as 36012? I was considering 37187 but I don't think that would describe this cardiac procedure.
Procedures performed: Percutaneous catheter-based extraction of tricuspid valve vegetations (AngioVAC Procedure) with AngioVac 3 device, Ultrasound-guided vascular access, Placement of Gore 26-Fr. DrySeal sheath into right internal jugular vein, Placement of Fem-flex 18-Fr. cannula into right femoral vein, Fluoroscopy, TEE interpretation, Initiation and management of venovenous bypass circuit.
Operation Details: After appropriate informed consent was obtained, the patient was brought to the hybrid OR and placed in supine position on the OR table. He was intubated and placed under general endotracheal anesthesia. Standard monitoring lines and a TEE probe were placed. I interpreted the TEE as showing severe tricuspid regurgitation, native tricuspid valve endocarditis with a large > 1 cm vegetation involving the anterior leaflet of the tricuspid valve and preserved/hyperdynamic ventricular function. Following sterile prep and drape, i used ultrasound guidance to access the right femoral vein. Then, an Amplatz super stiff wire was advanced into the IVC under TEE and fluoroscopic guidance. The patient was then heparinized for the AngioVAC procedure. The access site was serially dilated, and then, a 18-Fr. Fem-flex cannula was advanced into the right femoral vein. The cannula was flushed with heparinized saline. Then, an Amplatz super stiff wire was advanced via the indwelling right IJ sheath and the sheath removed. The access site was dilated, and ultimately, a 26-Fr. GoreDrySeal sheath was placed under TEE and fluoroscopic guidance. The femoral venous sheath and the AngioVac 3 device were then connected, using wet-to-wet connections to the venovenous bypass circuit. Next, the AngioVac 3 device was brought into the right IJ sheath, and venovenous bypass initiated up to a flow rate of 3 L/minute without cavitation. The oversleeve was withdrawn to expose the AngioVac 3 device in the right atrium, and it was positioned towards the tricuspid valve under 3D TEE guidance. Then, using multiple passes with the AngioVac 3 device over the anterior leaflet vegetations, i was able to remove all Surgery Date and Time: 01/22/2021 0800 Primary Procedure: ANGIOVAC Secondary Procedure: TRANSESOPHAGEAL ECHOCARDIOGRAM mobile vegetation components from the tricuspid valve leaflets. 3D TEE showed, as expected, persistent severe TR, and leaflet flail, as well as some ventricular components of infection adherent to the papillary muscles. Once we had achieved complete debulking of the tricuspid valve leaflets, the AngioVac 3 device was withdrawn into the sheath, the venovenous bypass circuit was then interrupted and the trap inspected. There were copious amounts of vegetations noted in the trap. The venous blood was withdrawn to cell saver, processed and returned to the patient. The IJ and femoral sheaths were withdrawn and a single figure-of-8 suture placed at each location and manual compression was used for hemostasis. The heparin effect was reversed with protamine. The patient was extubated in the hybrid OR, and transferred to the PACU in stable condition.