margaret fahy
Guru
Hi Folks,
In report below, for the NG portion, dr. says he removed existing NG and placed a new NG.
Firstly - I don't consider this sufficient documentation with which to bill, am I correct?
Secondly - what code would you use for this.....an NG placement (43752)?
Please give me some input here.
Thanks so much.
Margie
CLINICAL HISTORY: 29-month-old male patient with history of
neuroblastoma, needs central line for chemotherapy. Here for port
placement.
PROCEDURE: Limited Ultrasound of the left neck was performed to
identify the left internal jugular vein and choose a site for
insertion of the central line. The skin overlying the site was
marked. The skin of the left neck and chest was prepped and
draped in sterile fashion and local anesthesia using Ropivicaine
was infused at the venous insertion site. Using real- time
ultrasound guidance a 21g needle was inserted into the right
internal jugular vein. Once venous blood return was obtained a
0.018" mandril wire was inserted into the vein and advanced to
the right atrium. The small dermatotomy was made, the tract was
dilated, and a 6.5 the peel-away sheath was inserted into the
vein.
The chest insertion site was anesthetized with Ropivicaine and a
2 cm dermatotomy was made. In standard fashion a subcutaneous
pocket was formed. A subcutaneous tunnel was formed from the
cephalad edge of the pocket to the venous insertion site. A
6.5F single lumen catheter was attached to the port reservoir.
The catheter was pulled through the tunnel to the venous
insertion site, and the reservoir was placed into the pocket.
The catheter was measured and cut to 15 cm. Via the peel-away
sheath the catheter was inserted in the left internal jugular
vein and advanced with fluoroscopic guidance until the tip was in
the SVC/RA junction. The peel-away sheath was then removed. The
neck insertion site was closed with4-0 vicryl, Dermabond and
steristrips. The chest incision was closed with 3-0 Vicryl
interrupted subcutaneous stitches, and a running 4-0 Vicryl
subcuticular stitch, dermabond and steri-strips. Both sites were
dressed with sterile occlusive dressings. The port was accessed
with an 20 gauge,3/4 inches Huber needle. The port aspirated and
flushed easily and was heparinized.
Then, attention was drawn to the indwelling NG tube, which was
removed. A new NG tube was placed.
There were no complications and the patient left the IR suite in
stable condition. l was present for the entire
procedure.
FINDINGS: Limited ultrasound of the left neck showed a patent
left internal jugular vein. A fluoroscopic image taken at the
end of the procedure showed the tip of the catheter at the SVC/RA
junction.
Permanent US and fluoroscopic images were obtained and stored in
the PACS system.
IMPRESSION
1. Successful, uncomplicated placement of a 6.5 French, 15 cm
single lumen left chest port via the left internal jugular vein
with the tip in the SVC/RA junction.
2. Exchange of NG tube.
In report below, for the NG portion, dr. says he removed existing NG and placed a new NG.
Firstly - I don't consider this sufficient documentation with which to bill, am I correct?
Secondly - what code would you use for this.....an NG placement (43752)?
Please give me some input here.
Thanks so much.
Margie
CLINICAL HISTORY: 29-month-old male patient with history of
neuroblastoma, needs central line for chemotherapy. Here for port
placement.
PROCEDURE: Limited Ultrasound of the left neck was performed to
identify the left internal jugular vein and choose a site for
insertion of the central line. The skin overlying the site was
marked. The skin of the left neck and chest was prepped and
draped in sterile fashion and local anesthesia using Ropivicaine
was infused at the venous insertion site. Using real- time
ultrasound guidance a 21g needle was inserted into the right
internal jugular vein. Once venous blood return was obtained a
0.018" mandril wire was inserted into the vein and advanced to
the right atrium. The small dermatotomy was made, the tract was
dilated, and a 6.5 the peel-away sheath was inserted into the
vein.
The chest insertion site was anesthetized with Ropivicaine and a
2 cm dermatotomy was made. In standard fashion a subcutaneous
pocket was formed. A subcutaneous tunnel was formed from the
cephalad edge of the pocket to the venous insertion site. A
6.5F single lumen catheter was attached to the port reservoir.
The catheter was pulled through the tunnel to the venous
insertion site, and the reservoir was placed into the pocket.
The catheter was measured and cut to 15 cm. Via the peel-away
sheath the catheter was inserted in the left internal jugular
vein and advanced with fluoroscopic guidance until the tip was in
the SVC/RA junction. The peel-away sheath was then removed. The
neck insertion site was closed with4-0 vicryl, Dermabond and
steristrips. The chest incision was closed with 3-0 Vicryl
interrupted subcutaneous stitches, and a running 4-0 Vicryl
subcuticular stitch, dermabond and steri-strips. Both sites were
dressed with sterile occlusive dressings. The port was accessed
with an 20 gauge,3/4 inches Huber needle. The port aspirated and
flushed easily and was heparinized.
Then, attention was drawn to the indwelling NG tube, which was
removed. A new NG tube was placed.
There were no complications and the patient left the IR suite in
stable condition. l was present for the entire
procedure.
FINDINGS: Limited ultrasound of the left neck showed a patent
left internal jugular vein. A fluoroscopic image taken at the
end of the procedure showed the tip of the catheter at the SVC/RA
junction.
Permanent US and fluoroscopic images were obtained and stored in
the PACS system.
IMPRESSION
1. Successful, uncomplicated placement of a 6.5 French, 15 cm
single lumen left chest port via the left internal jugular vein
with the tip in the SVC/RA junction.
2. Exchange of NG tube.