gnuno76
New
Hi, I am having an issue with finding the proper coding for the below operative report and wanted to know if anyone has experience with coding something like this. Thank you!
PROCEDURES:
1. Placement of catheter in left upper arm arteriovenous fistula and venogram.
2. Venous angioplasty severe stenosis in arteriovenous fistula anastomosis, 5 mm balloon.
3. Angioplasty of right axillary vein occlusion 7 mm balloon.
4. Stent placement of left axillary stenosis. 8 mm x 40 mm stent.
5. Radiological supervision and interpretation for venous angioplasty.
6. Ultrasound guidance for access of the left arm arteriovenous fistula x 2, arterial side and venous side.
7. Suction thrombectomy CAT D.
INDICATIONS: Patient is a 76 yo F with a right arm loop graft, multiple occlusions, stenosis and venous outflow issues. Consented for thrombectomy and interventions.
DETAILS OF PROCEDURE: Patient was brought to the angio suite and was placed on the table in supine position. Her right arm was prepped and draped in the usual sterile fashion. Under moderate conscious sedation and local anesthesia, a retrograde and antegrade ultrasound-guided cannulation of the graft was successful using micropuncture needle. Over 0.018 wire, the micropuncture sheath was inserted, at which point, the wire was exchanged for a 0.035 J-tip wire and the sheath was exchanged for a Brite Tip 6-French sheath towards the venous side and a 7 french towards the arterial side. Initial venogram performed showed occlusion of the graft. I got access into the axillary vein and was patent. I then did a pullback angiogram and was the culprit issue in the distal previous stent placed. I ballooned with a 7 mm balloon and saw persistent issue there. I then placed a 8 mm stent and post dilated, this resolved the issue. I then got access with a glide with a kumpe into the brachial artery. I did a arterial angiogram and saw a severe stenosis at the anastomosis area in the graft. I ballooned with a 4 mm and then a 5 mm balloon. Did fogarty technique and this was chronic. I then did suction thromebctomy with CATD, I was able to remove some disease but there was a persistent narrowing just passed the anastomosis in the graft. I tried ballooning. I did not have any short 2cm stents to stent this lesion. There was good flow. This will have to be addressed soon in a couple weeks.
PROCEDURES:
1. Placement of catheter in left upper arm arteriovenous fistula and venogram.
2. Venous angioplasty severe stenosis in arteriovenous fistula anastomosis, 5 mm balloon.
3. Angioplasty of right axillary vein occlusion 7 mm balloon.
4. Stent placement of left axillary stenosis. 8 mm x 40 mm stent.
5. Radiological supervision and interpretation for venous angioplasty.
6. Ultrasound guidance for access of the left arm arteriovenous fistula x 2, arterial side and venous side.
7. Suction thrombectomy CAT D.
INDICATIONS: Patient is a 76 yo F with a right arm loop graft, multiple occlusions, stenosis and venous outflow issues. Consented for thrombectomy and interventions.
DETAILS OF PROCEDURE: Patient was brought to the angio suite and was placed on the table in supine position. Her right arm was prepped and draped in the usual sterile fashion. Under moderate conscious sedation and local anesthesia, a retrograde and antegrade ultrasound-guided cannulation of the graft was successful using micropuncture needle. Over 0.018 wire, the micropuncture sheath was inserted, at which point, the wire was exchanged for a 0.035 J-tip wire and the sheath was exchanged for a Brite Tip 6-French sheath towards the venous side and a 7 french towards the arterial side. Initial venogram performed showed occlusion of the graft. I got access into the axillary vein and was patent. I then did a pullback angiogram and was the culprit issue in the distal previous stent placed. I ballooned with a 7 mm balloon and saw persistent issue there. I then placed a 8 mm stent and post dilated, this resolved the issue. I then got access with a glide with a kumpe into the brachial artery. I did a arterial angiogram and saw a severe stenosis at the anastomosis area in the graft. I ballooned with a 4 mm and then a 5 mm balloon. Did fogarty technique and this was chronic. I then did suction thromebctomy with CATD, I was able to remove some disease but there was a persistent narrowing just passed the anastomosis in the graft. I tried ballooning. I did not have any short 2cm stents to stent this lesion. There was good flow. This will have to be addressed soon in a couple weeks.