Wiki Cath placed prior to tavr

[suela923@aol.com]

Is the cath placement or ultrasound billable or would this be part of the TAVR procedure?

Thanks!
Sue


Ultrasound and fluoroscopic guided left radial artery access and placement of catheter into the infrarenal abdominal aorta.

History: Preop TAVR. Renal insufficiency. Catheter placement prior to CT angiogram. On Coumadin.

Technique: Timeout performed. Skin over left wrist prepped and draped sterilely. Lidocaine 2% used as local anesthetic. Moderate sedation also administered. Ultrasound used to determine potential access sites and for real-time guidance into the left radial artery. Images recorded and made part of the patient's permanent medical record. A 4-French dilator placed and 250 mcg Cardene mixed with 200 mcg Nitrostat were delivered diluted in 20 cc saline into the left radial artery. 5-French sheath placed. Through this sheath, Cobra catheter was advanced into the descending thoracic aorta. This was exchanged for a 5-French straight flush catheter. Catheter was advanced to the L1-L2 level and an x-ray was obtained. No complications occurred. Patient was then transferred to CAT scan for CT angiography. Following CT angiography, catheter and sheath were removed. Hemostasis achieved at the left radial artery puncture site. No complications occurred.

Findings: Left radial artery is calcified and small but patent. Needle is seen coursing into the artery. There are AICD-pacemaker wires present. Significant arterial calcification. Aorta is not aneurysmal. 5-French straight flush catheter advanced into the abdominal aorta at the L1-L2 level in excellent position and orientation. Excellent blood return.


Result Impression


Successful placement of a straight flush catheter into the infrarenal abdominal aorta via left radial artery access.

 

[dpeoples]

Is the cath placement or ultrasound billable or would this be part of the TAVR procedure?

Thanks!
Sue


Ultrasound and fluoroscopic guided left radial artery access and placement of catheter into the infrarenal abdominal aorta.

History: Preop TAVR. Renal insufficiency. Catheter placement prior to CT angiogram. On Coumadin.

Technique: Timeout performed. Skin over left wrist prepped and draped sterilely. Lidocaine 2% used as local anesthetic. Moderate sedation also administered. Ultrasound used to determine potential access sites and for real-time guidance into the left radial artery. Images recorded and made part of the patient's permanent medical record. A 4-French dilator placed and 250 mcg Cardene mixed with 200 mcg Nitrostat were delivered diluted in 20 cc saline into the left radial artery. 5-French sheath placed. Through this sheath, Cobra catheter was advanced into the descending thoracic aorta. This was exchanged for a 5-French straight flush catheter. Catheter was advanced to the L1-L2 level and an x-ray was obtained. No complications occurred. Patient was then transferred to CAT scan for CT angiography. Following CT angiography, catheter and sheath were removed. Hemostasis achieved at the left radial artery puncture site. No complications occurred.

Findings: Left radial artery is calcified and small but patent. Needle is seen coursing into the artery. There are AICD-pacemaker wires present. Significant arterial calcification. Aorta is not aneurysmal. 5-French straight flush catheter advanced into the abdominal aorta at the L1-L2 level in excellent position and orientation. Excellent blood return.


Result Impression


Successful placement of a straight flush catheter into the infrarenal abdominal aorta via left radial artery access.

Was the catheter placed just prior to TAVR (same date etc.)? Was it left in place until TAVR was completed? If the answer to those questions is "yes" then it is included with TAVR. If the answer is "no" then I would like code separtly for the cath placement only...36200.

HTH