ckupfner32
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I need help not exactly sure how to bill this procedure.
Indications
Pulmonary embolism with acute cor pulmonale, unspecified chronicity, unspecified pulmonary embolism type (CMS HCC) [I26.09 (ICD-10-CM)]
Dyspnea [R06.00 (ICD-10-CM)]
Procedure Anesthesia Type
CARD PULMONARY ANGIO - SELECTIVE
CARD THROMBECTOMY
CARD US GUIDED ACCESS
Reason for Procedure
Submassive Intermediate-high risk Saddle Pulmonary Embolism with severe right heart strain.
Procedure Details
After informed consent the patient was brought to the catheterization suite. He was laid supine on the catheterization table. Bilateral groins were prepped and draped in the normal sterile fashion using using chlorhexidine. Next lidocaine was used to anesthetize the area of the right femoral vein. Ultrasound guidance was used to access the right common femoral vein. Venogram was done of the right common femoral vein through the iliacs and an IVC verify no thrombus present. There was mild spasm in the external iliac vein, but no evidence of thrombus. At this time the pigtail catheter was advanced over a J-wire and up into the pulmonary arteries. Pulmonary artery pressures were measured. Selective left and right pulmonary angiography was done. Next an Amplatz wire was placed through the pigtail catheter and into the right main pulmonary artery. The 24 French INR a sheath was then exchanged with the 6 French sheath in the right common femoral vein. Next 24 French an RV catheter was advanced over the wire up into the right pulmonary artery. Aspiration thrombectomy was done from here. Large amount of clot was aspirated. Next the 20 French curved NR catheter was placed in a telescoping fashion into the right proximal most branching vessel. Aspiration was done through here multiple times. Clot was retrieved. Next selective angiography was done through this. Next the catheter pulled back to the left main pulmonary artery. The catheter was advanced through the left main pulmonary artery with aspiration into the subsegmental portions. Clot was retrieved from this segment. The catheter was then used for selective pulmonary angiography of the left subsegmental vessels. Catheter was then pulled back and a final selective left pulmonary angiogram was done showing no evidence residual clot in significant improvement in filling throughout the lungs. The catheter was then pulled back and advanced back into the right main pulmonary artery. The 20 French curved catheter was advanced up into the right truncus. Aspiration was done from here with retrieval of clot. That is selective angiography was done of the right truncus showing no evidence of residual clot. The catheter was pulled back and a final angiogram of the right main pulmonary artery was done showing no significant residual clot in the right system and good flow/opacification throughout the right pulmonary tree. A final pulmonary artery pressure measurement was done, showing normalization of pressures. At this point the catheters were removed. Just prior to removal a venogram was done to verify no residual clot in the IVC, there was not. Next the sheath was removed, and a figure-of-eight stitch placed across the access site. 15 minutes of manual direct pressure was held. Hemostasis was noted without any complications. The patient tolerated procedure well and was transferred to ICU for post procedural care.
Interpretation
1. Successful bilateral aspiration thrombectomy from pulmonary arteries
Recommendations
Standard post-procedural care
Continue medical management and risk factor modification
- continue heparin overnight
- bedrest 6 hours
- we will pull stitch in the morning
- oral anticoagulation can be started tomorrow
- transthoracic echocardiogram to verify RV size in about 72 hours or more
Thanks any help is greatly appreciated
Indications
Pulmonary embolism with acute cor pulmonale, unspecified chronicity, unspecified pulmonary embolism type (CMS HCC) [I26.09 (ICD-10-CM)]
Dyspnea [R06.00 (ICD-10-CM)]
Procedure Anesthesia Type
CARD PULMONARY ANGIO - SELECTIVE
CARD THROMBECTOMY
CARD US GUIDED ACCESS
Reason for Procedure
Submassive Intermediate-high risk Saddle Pulmonary Embolism with severe right heart strain.
Procedure Details
After informed consent the patient was brought to the catheterization suite. He was laid supine on the catheterization table. Bilateral groins were prepped and draped in the normal sterile fashion using using chlorhexidine. Next lidocaine was used to anesthetize the area of the right femoral vein. Ultrasound guidance was used to access the right common femoral vein. Venogram was done of the right common femoral vein through the iliacs and an IVC verify no thrombus present. There was mild spasm in the external iliac vein, but no evidence of thrombus. At this time the pigtail catheter was advanced over a J-wire and up into the pulmonary arteries. Pulmonary artery pressures were measured. Selective left and right pulmonary angiography was done. Next an Amplatz wire was placed through the pigtail catheter and into the right main pulmonary artery. The 24 French INR a sheath was then exchanged with the 6 French sheath in the right common femoral vein. Next 24 French an RV catheter was advanced over the wire up into the right pulmonary artery. Aspiration thrombectomy was done from here. Large amount of clot was aspirated. Next the 20 French curved NR catheter was placed in a telescoping fashion into the right proximal most branching vessel. Aspiration was done through here multiple times. Clot was retrieved. Next selective angiography was done through this. Next the catheter pulled back to the left main pulmonary artery. The catheter was advanced through the left main pulmonary artery with aspiration into the subsegmental portions. Clot was retrieved from this segment. The catheter was then used for selective pulmonary angiography of the left subsegmental vessels. Catheter was then pulled back and a final selective left pulmonary angiogram was done showing no evidence residual clot in significant improvement in filling throughout the lungs. The catheter was then pulled back and advanced back into the right main pulmonary artery. The 20 French curved catheter was advanced up into the right truncus. Aspiration was done from here with retrieval of clot. That is selective angiography was done of the right truncus showing no evidence of residual clot. The catheter was pulled back and a final angiogram of the right main pulmonary artery was done showing no significant residual clot in the right system and good flow/opacification throughout the right pulmonary tree. A final pulmonary artery pressure measurement was done, showing normalization of pressures. At this point the catheters were removed. Just prior to removal a venogram was done to verify no residual clot in the IVC, there was not. Next the sheath was removed, and a figure-of-eight stitch placed across the access site. 15 minutes of manual direct pressure was held. Hemostasis was noted without any complications. The patient tolerated procedure well and was transferred to ICU for post procedural care.
Interpretation
1. Successful bilateral aspiration thrombectomy from pulmonary arteries
Recommendations
Standard post-procedural care
Continue medical management and risk factor modification
- continue heparin overnight
- bedrest 6 hours
- we will pull stitch in the morning
- oral anticoagulation can be started tomorrow
- transthoracic echocardiogram to verify RV size in about 72 hours or more
Thanks any help is greatly appreciated