suela923@aol.com
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36561, 77001, 76937, 36561-74, 77001, 36005-59, 75820-59
was billing the 36005-59 and 75820-59 overkill? Any thoughts?!
Thanks,
Sue
PowerPort placement
History: 60 female with cancer in need of IV access for chemotherapy.
Technique: After the patient was appropriately identified in the preprocedure holding area, informed consent was obtained for a power port placement. Risks benefits and alternatives including but not limited to bleeding infection pain and pneumothorax were explained to the patient and she agreed to proceed. The patient was transferred to the angiography suite placed on the angiography table in supine position. Her chest and neck were prepped and draped in the standard surgical fashion. Maximal sterile barrier technique was used for this central access procedure. The left side was initially chose for placement of this PowerPort as the patient has a pacemaker defibrillator placed on her right chest. 1% lidocaine with epinephrine was infiltrated into the patient's left neck and chest area. Ultrasound was used to image the left neck. The left internal jugular vein was shown to be occluded. There was a patent external jugular. Hardcopy image was saved on PACS documenting this service. Using real-time ultrasound guidance a needle was placed into the left external jugular vein. An 035 guidewire was inserted through this needle. I was unable to advance this wire into the patient's right atrium. Next I imaged the patient's left subclavian vein. Using real-time ultrasound guidance a needle was placed into the patient's left subclavian vein. An 035 wire was advanced through this needle and this appeared to traverse to the left side of the heart. At this point I performed a venogram which demonstrated what appeared to be a duplicated superior vena cava without communication from left to right. At this point I elected to abandon left chest placement and move to the right. I performed a digital spot image of the patient's left chest to rule out pneumothorax. There did not appear to be a pneumothorax. Her right neck and chest were prepped and draped in the standard surgical fashion. 1% lidocaine with epinephrine was infiltrated into the subcutaneous tissue surrounding the patient's right neck and chest. Ultrasound was used to image the patient's right neck. The right internal jugular vein was shown to be patent. Hardcopy image was saved on PACS documenting this service. Using real-time ultrasound guidance a needle was placed into the patient's right internal jugular vein. Attempts at placing the guidewire through this needle into the patient's right atrium was unsuccessful. Next a 2-35 Glidewire and placed this through the needle and I was able to place this wire into the patient's right atrium. It was very difficult due to the pre-existing wires from the patient's pacemaker defibrillator. I used a 4-French Bernstein catheter to maintain the access I had with the wire. Next a removed a Glidewire and placed an 035 Bentson wire through the Bernstein catheter. I was able to advance this into the patient's IVC. An 8-French peel-away sheath was advanced over the wire into the patient's right atrium. The A 3 cm incision was made on the patient's right anterior chest wall. A pocket was formed using blunt dissection. A subcutaneous tunnel was also created from this skin incision to the patient's right internal jugular vein access. Through this the PowerPort catheter was tunneled. Next the powerport catheter was placed into the patient's right atrium. This was trimmed at 16 cm and attached to the power port. The power port was sutured to the anterior chest wall using 3-0 Vicryl suture. The pocket was then closed with a layer for a 3-0 Vicryl suture followed by a lateral 4 Monocryl suture to approximate the skin. A completion x-ray from good placement of the tip of the PowerPort catheter with its tip at the patient's cavoatrial junction with no kinking along the course of the catheter. The port was flushed with heparinized saline and there was adequate flow through the catheter.
was billing the 36005-59 and 75820-59 overkill? Any thoughts?!
Thanks,
Sue
PowerPort placement
History: 60 female with cancer in need of IV access for chemotherapy.
Technique: After the patient was appropriately identified in the preprocedure holding area, informed consent was obtained for a power port placement. Risks benefits and alternatives including but not limited to bleeding infection pain and pneumothorax were explained to the patient and she agreed to proceed. The patient was transferred to the angiography suite placed on the angiography table in supine position. Her chest and neck were prepped and draped in the standard surgical fashion. Maximal sterile barrier technique was used for this central access procedure. The left side was initially chose for placement of this PowerPort as the patient has a pacemaker defibrillator placed on her right chest. 1% lidocaine with epinephrine was infiltrated into the patient's left neck and chest area. Ultrasound was used to image the left neck. The left internal jugular vein was shown to be occluded. There was a patent external jugular. Hardcopy image was saved on PACS documenting this service. Using real-time ultrasound guidance a needle was placed into the left external jugular vein. An 035 guidewire was inserted through this needle. I was unable to advance this wire into the patient's right atrium. Next I imaged the patient's left subclavian vein. Using real-time ultrasound guidance a needle was placed into the patient's left subclavian vein. An 035 wire was advanced through this needle and this appeared to traverse to the left side of the heart. At this point I performed a venogram which demonstrated what appeared to be a duplicated superior vena cava without communication from left to right. At this point I elected to abandon left chest placement and move to the right. I performed a digital spot image of the patient's left chest to rule out pneumothorax. There did not appear to be a pneumothorax. Her right neck and chest were prepped and draped in the standard surgical fashion. 1% lidocaine with epinephrine was infiltrated into the subcutaneous tissue surrounding the patient's right neck and chest. Ultrasound was used to image the patient's right neck. The right internal jugular vein was shown to be patent. Hardcopy image was saved on PACS documenting this service. Using real-time ultrasound guidance a needle was placed into the patient's right internal jugular vein. Attempts at placing the guidewire through this needle into the patient's right atrium was unsuccessful. Next a 2-35 Glidewire and placed this through the needle and I was able to place this wire into the patient's right atrium. It was very difficult due to the pre-existing wires from the patient's pacemaker defibrillator. I used a 4-French Bernstein catheter to maintain the access I had with the wire. Next a removed a Glidewire and placed an 035 Bentson wire through the Bernstein catheter. I was able to advance this into the patient's IVC. An 8-French peel-away sheath was advanced over the wire into the patient's right atrium. The A 3 cm incision was made on the patient's right anterior chest wall. A pocket was formed using blunt dissection. A subcutaneous tunnel was also created from this skin incision to the patient's right internal jugular vein access. Through this the PowerPort catheter was tunneled. Next the powerport catheter was placed into the patient's right atrium. This was trimmed at 16 cm and attached to the power port. The power port was sutured to the anterior chest wall using 3-0 Vicryl suture. The pocket was then closed with a layer for a 3-0 Vicryl suture followed by a lateral 4 Monocryl suture to approximate the skin. A completion x-ray from good placement of the tip of the PowerPort catheter with its tip at the patient's cavoatrial junction with no kinking along the course of the catheter. The port was flushed with heparinized saline and there was adequate flow through the catheter.