mollyg489@gmail.com
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I am a little confused as to how I should code this. I think I have some of it covered but I dont know if I should code for the fluoro guidence.
Currently I have
36821-lt
36581-rt
OPERATIVE PROCEDURE:
1. Left upper arm arteriovenous fistula, brachiocephalic from the
antecubital fossa.
2. Placement of new right internal jugular tunneled hemodialysis catheter.
3. Removal of old hemodialysis catheter and extraction of fractured portion
of dialysis catheter foreign body from the inferior vena cava using a
lasso technique and fluoroscopic guidance.
DESCRIPTION OF PROCEDURE: Once the patient was prepped and draped in usual
sterile fashion, she was given 1% lidocaine with epinephrine as a local
anesthetic and IV sedation by the anesthesiologist. The old right IJ catheter
was removed. It was cut. We placed a guidewire down through this into the
superior vena cava and during this portion of the procedure, we essentially
lost the tip of the catheter into the cava. It did migrate down to the
inferior vena cava. We had a wire around it. We then had to put a sheet in
through the IJ and under fluoroscopic guidance, we retrieved this catheter tip
with a lasso through the sheath. Once we were able to do that, then we were
able to put a new wire down into the superior vena cava and place a new right
IJ tunneled hemodialysis catheter without any difficulty. This was sutured
into place with a 2-0 silk stay suture and the neck incision was closed with 3-
0 Vicryl in a simple interrupted subcuticular fashion. The patient tolerated
this portion of the procedure well and we then focused on the left arm AV
fistula. The patient was re-prepped and redraped with the left arm out and we
gave her 1% lidocaine with epinephrine again and continued our IV sedation.
Antecubital fossa was opened. The cephalic vein was dissected out. Branches
to the vein were divided and ligated with 3-0 silk free ties in continuity.
The vein was mobilized down to the brachial artery. An end-to-side
anastomosis between brachial artery and cephalic vein was performed with 6-0
Prolene in simple running fashion using 2 separate suture lines. The incision
was closed with 2-0 Vicryl in a simple interrupted fashion on the subcutaneous
tissue and 3-0 nylon in a simple running fashion on the skin. At the end of
the procedure, the patient had a good thrill in her fistula and Doppler
signals in the hand. The patient tolerated the procedure well and was found
to be stable in the recovery room postoperatively. Sponge and instrument
counts were correct x2. Preoperatively, the patient and her family understood
the risks of procedure to be bleeding, infection, pain, poor wound healing,
decreased circulation to the hand, and possible need for further dialysis
access surgery. They also understood that she could have a potentially
collapsed lung. With all this in mind, they want to go ahead with today's
surgery.
Currently I have
36821-lt
36581-rt
OPERATIVE PROCEDURE:
1. Left upper arm arteriovenous fistula, brachiocephalic from the
antecubital fossa.
2. Placement of new right internal jugular tunneled hemodialysis catheter.
3. Removal of old hemodialysis catheter and extraction of fractured portion
of dialysis catheter foreign body from the inferior vena cava using a
lasso technique and fluoroscopic guidance.
DESCRIPTION OF PROCEDURE: Once the patient was prepped and draped in usual
sterile fashion, she was given 1% lidocaine with epinephrine as a local
anesthetic and IV sedation by the anesthesiologist. The old right IJ catheter
was removed. It was cut. We placed a guidewire down through this into the
superior vena cava and during this portion of the procedure, we essentially
lost the tip of the catheter into the cava. It did migrate down to the
inferior vena cava. We had a wire around it. We then had to put a sheet in
through the IJ and under fluoroscopic guidance, we retrieved this catheter tip
with a lasso through the sheath. Once we were able to do that, then we were
able to put a new wire down into the superior vena cava and place a new right
IJ tunneled hemodialysis catheter without any difficulty. This was sutured
into place with a 2-0 silk stay suture and the neck incision was closed with 3-
0 Vicryl in a simple interrupted subcuticular fashion. The patient tolerated
this portion of the procedure well and we then focused on the left arm AV
fistula. The patient was re-prepped and redraped with the left arm out and we
gave her 1% lidocaine with epinephrine again and continued our IV sedation.
Antecubital fossa was opened. The cephalic vein was dissected out. Branches
to the vein were divided and ligated with 3-0 silk free ties in continuity.
The vein was mobilized down to the brachial artery. An end-to-side
anastomosis between brachial artery and cephalic vein was performed with 6-0
Prolene in simple running fashion using 2 separate suture lines. The incision
was closed with 2-0 Vicryl in a simple interrupted fashion on the subcutaneous
tissue and 3-0 nylon in a simple running fashion on the skin. At the end of
the procedure, the patient had a good thrill in her fistula and Doppler
signals in the hand. The patient tolerated the procedure well and was found
to be stable in the recovery room postoperatively. Sponge and instrument
counts were correct x2. Preoperatively, the patient and her family understood
the risks of procedure to be bleeding, infection, pain, poor wound healing,
decreased circulation to the hand, and possible need for further dialysis
access surgery. They also understood that she could have a potentially
collapsed lung. With all this in mind, they want to go ahead with today's
surgery.