iamlou
Networker
Hi all,
I'm reposting this and hope someone can help. In looking at it again, I'm wondering if I should only use 36010/75827? Any input is appreciated.
Hi,
I'm not super familiar with venography coding. I thought 36010 for the placement in the SVC, and 36005/75820 for the venography. Would I use anything else for the "Selective injections performed in both the
left internal and external jugular veins"? Thank you!!
PROCEDURES PERFORMED: Left upper extremity and left central venogram, and
attempted recanalization of left subclavian vein occlusion.
IMAGING MODALITY UTILIZED: Ultrasound and fluoroscopy.
ACCESS SITE: Right common femoral vein, left axillary vein.
CATHETER POSITION: Left axillary vein and subclavian vein via left
axillary vein approach, left innominate vein via right transfemoral vein
approach, left internal jugular vein, left external jugular vein via a
right transfemoral venous approach.
TECHNIQUE:
The skin overlying the left upper extremity AV access site, left axilla,
and right groin were sterilely prepped and draped as above.
Initially under ultrasound guidance, after achieving local anesthesia with
1% lidocaine, the right common femoral vein was accessed. Over a guidewire
a 6 French sheath was inserted followed by placement of a 5 French
Berenstein catheter which was advanced across the right heart into the SVC.
Injection performed. Catheter further advanced into the left innominate
vein. Injection performed. Central left subclavian vein occlusion defined.
Multiple attempts were made at sharp recanalization of the left central
vein chronic occlusion in a retrograde fashion from a transfemoral approach
with a selection of various guidewires including stiff Glidewire. These
were unsuccessful. The catheter prolapsed into the prominent left external
and internal jugular veins. Selective injections were performed in both the
left internal and external jugular veins.
As such, a left transaxillary approach was elected. Under ultrasound
guidance, after achieving local anesthesia, the left axillary vein was
accessed in the high axilla. Over a guidewire a 5 French sheath was
inserted, followed by placement of 5 French Berenstein catheter. Catheter
positioned in the left axillary vein. Injection was performed. Catheter
further advanced into the left subclavian vein laterally, injections
performed. Prominent cervical collaterals were defined. The central left
subclavian occlusion defined. With the catheter wedged at the level of the
occlusion centrally, multiple attempts at recanalization using a variety of
guidewires including sharp dissection with a stiff Glidewire both proximal
and distal ends were performed. These were unsuccessful. The guidewire was
unable to penetrate the chronic cap. As such, the procedure was terminated.
The access sites were removed, and compression applied and hemostasis
achieved.
FINDINGS: Chronic occlusion of the left subclavian vein centrally at the
junction with the left innominate vein. There is prominent cervical
collaterals that descend through the right neck and suprascapular region,
and reconstitute the left external and internal jugular veins which
decompress into the left innominate vein. Unsuccessful attempts at
recanalization as described in detail above.
COMPLICATIONS: None.
IMPRESSION: RIGHT TRANSFEMORAL AND LEFT TRANSAXILLARY LEFT CENTRAL CHEST
VENOGRAPHY DOCUMENTS HIGH-GRADE CHRONIC FOCAL OCCLUSION OF THE LEFT CENTRAL
SUBCLAVIAN VEIN, REFRACTORY TO ATTEMPTS AT RECANALIZATION FROM BOTH TRANS-
FEMORAL RETROGRADE, AND TRANSAXILLARY ANTEGRADE APPROACHES.
I'm reposting this and hope someone can help. In looking at it again, I'm wondering if I should only use 36010/75827? Any input is appreciated.
Hi,
I'm not super familiar with venography coding. I thought 36010 for the placement in the SVC, and 36005/75820 for the venography. Would I use anything else for the "Selective injections performed in both the
left internal and external jugular veins"? Thank you!!
PROCEDURES PERFORMED: Left upper extremity and left central venogram, and
attempted recanalization of left subclavian vein occlusion.
IMAGING MODALITY UTILIZED: Ultrasound and fluoroscopy.
ACCESS SITE: Right common femoral vein, left axillary vein.
CATHETER POSITION: Left axillary vein and subclavian vein via left
axillary vein approach, left innominate vein via right transfemoral vein
approach, left internal jugular vein, left external jugular vein via a
right transfemoral venous approach.
TECHNIQUE:
The skin overlying the left upper extremity AV access site, left axilla,
and right groin were sterilely prepped and draped as above.
Initially under ultrasound guidance, after achieving local anesthesia with
1% lidocaine, the right common femoral vein was accessed. Over a guidewire
a 6 French sheath was inserted followed by placement of a 5 French
Berenstein catheter which was advanced across the right heart into the SVC.
Injection performed. Catheter further advanced into the left innominate
vein. Injection performed. Central left subclavian vein occlusion defined.
Multiple attempts were made at sharp recanalization of the left central
vein chronic occlusion in a retrograde fashion from a transfemoral approach
with a selection of various guidewires including stiff Glidewire. These
were unsuccessful. The catheter prolapsed into the prominent left external
and internal jugular veins. Selective injections were performed in both the
left internal and external jugular veins.
As such, a left transaxillary approach was elected. Under ultrasound
guidance, after achieving local anesthesia, the left axillary vein was
accessed in the high axilla. Over a guidewire a 5 French sheath was
inserted, followed by placement of 5 French Berenstein catheter. Catheter
positioned in the left axillary vein. Injection was performed. Catheter
further advanced into the left subclavian vein laterally, injections
performed. Prominent cervical collaterals were defined. The central left
subclavian occlusion defined. With the catheter wedged at the level of the
occlusion centrally, multiple attempts at recanalization using a variety of
guidewires including sharp dissection with a stiff Glidewire both proximal
and distal ends were performed. These were unsuccessful. The guidewire was
unable to penetrate the chronic cap. As such, the procedure was terminated.
The access sites were removed, and compression applied and hemostasis
achieved.
FINDINGS: Chronic occlusion of the left subclavian vein centrally at the
junction with the left innominate vein. There is prominent cervical
collaterals that descend through the right neck and suprascapular region,
and reconstitute the left external and internal jugular veins which
decompress into the left innominate vein. Unsuccessful attempts at
recanalization as described in detail above.
COMPLICATIONS: None.
IMPRESSION: RIGHT TRANSFEMORAL AND LEFT TRANSAXILLARY LEFT CENTRAL CHEST
VENOGRAPHY DOCUMENTS HIGH-GRADE CHRONIC FOCAL OCCLUSION OF THE LEFT CENTRAL
SUBCLAVIAN VEIN, REFRACTORY TO ATTEMPTS AT RECANALIZATION FROM BOTH TRANS-
FEMORAL RETROGRADE, AND TRANSAXILLARY ANTEGRADE APPROACHES.