Wiki Documentation for 77001

[donnagullikson]

In the following report is there enough documentation to support billing 77001? Normally my physician will state "under fluoro guidance the tip of the catheter was positioned in the right atrium, but this report doesn't state tbat. Fluoro is only mentioned in the impression. Can I bill 77001?

After informed consent the right neck was prepped and draped in a sterile fashion. Local anesthesia was achieved using 1% lidocaine. Ultrasound evaluation of the neck demonstrates the right internal jugular vein to be patent, compressible, and of adequate caliber. Ultrasound was utlilzed to the right jugular vein. Following serial dilatation a 14-French by 15 cm non-tunneled triple-lumen dialysis catheter was placed with difficulty. The tip was positioned in the right atrium. The catheter flushes and aspirates freely. The catheter was secured with suture and packed with heparinized saline. Followup chest x-ray demonstrates the catheter to be in good position with no postprocedure pneumothorax. Permanent fluoroscopic and ultrasound images were obtained and recorded.

Impression:
Uncomplicated ultrasound and fluoroscopically guided right jugular non-tunneled dialysis catheter placement.

Thanks,

 

[Jim Pawloski]

In the following report is there enough documentation to support billing 77001? Normally my physician will state "under fluoro guidance the tip of the catheter was positioned in the right atrium, but this report doesn't state tbat. Fluoro is only mentioned in the impression. Can I bill 77001?

After informed consent the right neck was prepped and draped in a sterile fashion. Local anesthesia was achieved using 1% lidocaine. Ultrasound evaluation of the neck demonstrates the right internal jugular vein to be patent, compressible, and of adequate caliber. Ultrasound was utlilzed to the right jugular vein. Following serial dilatation a 14-French by 15 cm non-tunneled triple-lumen dialysis catheter was placed with difficulty. The tip was positioned in the right atrium. The catheter flushes and aspirates freely. The catheter was secured with suture and packed with heparinized saline. Followup chest x-ray demonstrates the catheter to be in good position with no postprocedure pneumothorax. Permanent fluoroscopic and ultrasound images were obtained and recorded.

Impression:
Uncomplicated ultrasound and fluoroscopically guided right jugular non-tunneled dialysis catheter placement.

Thanks,

In this report, I would say no to 77001 as it sound to me like it was done bedside. I like to see that "after access to the vein, a wire was placed through the rt atrium with the tip in the IVC." Then the catheter was placed with the tip in the right atrium. Then I like to see how much fluoroscopy was used. The last part which made me question was "Followup chest x-ray demonstrates the catheter is in good position with no postprocedure pneumothorax. Why the chest x-ray after using fluoro? Also that would be part of the procedure and is not billable.
HTH,
Jim Pawloski, CIRCC