nlbarnes
Expert
I think I'm wrong on a couple of codes. I've got:
75978
35476
36012
75820
37212
75978
77001?
POSTOPERATIVE DIAGNOSIS:
Paget-Schroetter syndrome of right subclavian vein.
PROCEDURES:
1. Venogram, right upper extremity.
2. Venoplasty of right subclavian vein.
3. Placement of infusion catheter for thrombolysis.
4. Ultrasound-guided access of right basilic vein.
5. Diagnosis and interpretation of above.
OPERATIVE FINDINGS:
Patent basilic vein with thrombus noted in right axillary and
subclavian vein. Patent superior vena cava.
DESCRIPTION OF PROCEDURE:
The right arm was anesthetized under ultrasound guidance above the basilic vein. A
small nick in the skin was made with an 11 blade. The basilic vein
was attempted to be accessed, but a wire could not be passed at the
site of initial venipuncture. A second area was anesthetized under
local anesthesia and ultrasound guidance and more proximally on the
vein, and this was successfully accessed using the micropuncture
catheter kit and needle. The micropuncture catheter was up-sized to a
6-French sheath over a J-wire. A KMP catheter was placed into the
distal basilic vein after an initial venogram was shot and subsequent
venography was performed through the KMP catheter. A Glidewire was
used to cross a portion of the occluded vein, but could not cross with
the KMP alone. A Seeker catheter in conjunction with the Glidewire
was able to successfully traverse the thrombus and occlusion of the
right subclavian vein. The Glidewire was then exchanged for a
Supracore wire. A 5 mm x 80 mm balloon was used to perform venoplasty
of the axillary and subclavian vein. This demonstrated patency
without evidence of extravasation. A 10 cm multi-sideport infusion
catheter was then placed across the subclavian vein and axillary vein,
and extended into the initial portion of the superior vena cava. This
infusion catheter was then secured in place as was a 6-French sheath
with a single silk suture and dressing. The infusion catheter was
hooked up to a tPA infusion line, and the sideport of the sheath was
hooked up to a heparin infusion line. The patient was awakened and
transferred to the intensive care unit to undergo overnight
thrombolysis of her chronic-appearing right subclavian vein clot.
75978
35476
36012
75820
37212
75978
77001?
POSTOPERATIVE DIAGNOSIS:
Paget-Schroetter syndrome of right subclavian vein.
PROCEDURES:
1. Venogram, right upper extremity.
2. Venoplasty of right subclavian vein.
3. Placement of infusion catheter for thrombolysis.
4. Ultrasound-guided access of right basilic vein.
5. Diagnosis and interpretation of above.
OPERATIVE FINDINGS:
Patent basilic vein with thrombus noted in right axillary and
subclavian vein. Patent superior vena cava.
DESCRIPTION OF PROCEDURE:
The right arm was anesthetized under ultrasound guidance above the basilic vein. A
small nick in the skin was made with an 11 blade. The basilic vein
was attempted to be accessed, but a wire could not be passed at the
site of initial venipuncture. A second area was anesthetized under
local anesthesia and ultrasound guidance and more proximally on the
vein, and this was successfully accessed using the micropuncture
catheter kit and needle. The micropuncture catheter was up-sized to a
6-French sheath over a J-wire. A KMP catheter was placed into the
distal basilic vein after an initial venogram was shot and subsequent
venography was performed through the KMP catheter. A Glidewire was
used to cross a portion of the occluded vein, but could not cross with
the KMP alone. A Seeker catheter in conjunction with the Glidewire
was able to successfully traverse the thrombus and occlusion of the
right subclavian vein. The Glidewire was then exchanged for a
Supracore wire. A 5 mm x 80 mm balloon was used to perform venoplasty
of the axillary and subclavian vein. This demonstrated patency
without evidence of extravasation. A 10 cm multi-sideport infusion
catheter was then placed across the subclavian vein and axillary vein,
and extended into the initial portion of the superior vena cava. This
infusion catheter was then secured in place as was a 6-French sheath
with a single silk suture and dressing. The infusion catheter was
hooked up to a tPA infusion line, and the sideport of the sheath was
hooked up to a heparin infusion line. The patient was awakened and
transferred to the intensive care unit to undergo overnight
thrombolysis of her chronic-appearing right subclavian vein clot.