suela923@aol.com
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Would you code 36011 for catheter placement for embolization? I am not sure if the code 37241 includes the catheter placement unless it's for a diagnostic study. Thanks! Sue
Procedure: Left arm fistulogram and balloon angioplasty of stenotic segment. Coil embolization of venous outflow branch.
Indication: Poor maturation.
Results: Patient was identified and brought to the vascular unit. The left arm was prepped and draped in the usual sterile fashion. 2% lidocaine was used to infiltrate the skin over the proximal AV fistula. A micropuncture technique was used to access the fistula and a formal fistulogram was performed with the following findings. The arterial anastomoses is patent. The proximal portion of the fistula is patent. The midportion of the AV fistula has a moderate stenoses. There is one large outflow branch off the midportion of the fistula filling the deep system. The distal portion of the AV fistula is patent. The central veins are all patent without significant stenoses. The mid AV fistula stenotic segment was crossed with an angled Glidewire and balloon angioplasty was performed with a 6 mm Powerflex balloon. The result was suboptimal therefore a 7 mm Powerflex balloon was utilized with good result. Next the balloon catheter was exchanged out for a Berenstein catheter and the large venous outflow branch wAS cannulated with a Berenstein catheter and coil embolized with 5 mm and 6 mm coils. Excellent result was obtained. I then performed a completion study showing spasm in the mid segment AV fistula. This was re balloon angioplastied with a 6 mm Powerflex balloon. Excellent result was obtained. At the completion of the case the balloon and wire were removed. Pressure was held for 10 minutes without hematoma. Patient tolerated the procedure well and left in stable condition.
Result Impression
Stenoses in the midportion of the AV fistula, primarily treated with balloon angioplasty with excellent result. Large outflow branch filling the deep system, successfully treated with coil embolization.
Procedure: Left arm fistulogram and balloon angioplasty of stenotic segment. Coil embolization of venous outflow branch.
Indication: Poor maturation.
Results: Patient was identified and brought to the vascular unit. The left arm was prepped and draped in the usual sterile fashion. 2% lidocaine was used to infiltrate the skin over the proximal AV fistula. A micropuncture technique was used to access the fistula and a formal fistulogram was performed with the following findings. The arterial anastomoses is patent. The proximal portion of the fistula is patent. The midportion of the AV fistula has a moderate stenoses. There is one large outflow branch off the midportion of the fistula filling the deep system. The distal portion of the AV fistula is patent. The central veins are all patent without significant stenoses. The mid AV fistula stenotic segment was crossed with an angled Glidewire and balloon angioplasty was performed with a 6 mm Powerflex balloon. The result was suboptimal therefore a 7 mm Powerflex balloon was utilized with good result. Next the balloon catheter was exchanged out for a Berenstein catheter and the large venous outflow branch wAS cannulated with a Berenstein catheter and coil embolized with 5 mm and 6 mm coils. Excellent result was obtained. I then performed a completion study showing spasm in the mid segment AV fistula. This was re balloon angioplastied with a 6 mm Powerflex balloon. Excellent result was obtained. At the completion of the case the balloon and wire were removed. Pressure was held for 10 minutes without hematoma. Patient tolerated the procedure well and left in stable condition.
Result Impression
Stenoses in the midportion of the AV fistula, primarily treated with balloon angioplasty with excellent result. Large outflow branch filling the deep system, successfully treated with coil embolization.
