stephanie7480
Guest
Here is the note of the procedure only:
OPERATIVE SUMMARY: First, 1 % lidocaine was infiltrated at the distal-most
portion of the fistula. An 18-gauge thin-walled needle was then introduced.
A short 6-French sheath was placed. Next, by compressing the outflow of the
fistula, the arterial anastomosis was imaged. Next, remaining portion of the
fistula and central veins were imaged. This demonstrated a bifid cephalic neck. No hemodynamically significant stenosis in side branches, in the midportion and distal fistula. Next using a covered stent, mid portion of the fistula and side branch were covered. Next. the more distal side branch was then coiled with four 8 mm coils. Completion film demonstrated marked improvement. The covered stent, I believe will allow the apex to fill the fistula. It was also marked. We can start using it immediately. The patient tolerated the procedure well. There were no complications.
I read this to be an intervention with the stent and an embolization with the coils because of the use of the words "mid" and "distal". Therefore coding this as 37241 37236-59 36147.
I am aware that stents can be used with coils to "provide latticework for coil deployment" which means I would not report the stent but the provider does not mention that.
What do you think? Please provide rational for your response. Thanks for your help.
OPERATIVE SUMMARY: First, 1 % lidocaine was infiltrated at the distal-most
portion of the fistula. An 18-gauge thin-walled needle was then introduced.
A short 6-French sheath was placed. Next, by compressing the outflow of the
fistula, the arterial anastomosis was imaged. Next, remaining portion of the
fistula and central veins were imaged. This demonstrated a bifid cephalic neck. No hemodynamically significant stenosis in side branches, in the midportion and distal fistula. Next using a covered stent, mid portion of the fistula and side branch were covered. Next. the more distal side branch was then coiled with four 8 mm coils. Completion film demonstrated marked improvement. The covered stent, I believe will allow the apex to fill the fistula. It was also marked. We can start using it immediately. The patient tolerated the procedure well. There were no complications.
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I read this to be an intervention with the stent and an embolization with the coils because of the use of the words "mid" and "distal". Therefore coding this as 37241 37236-59 36147.
I am aware that stents can be used with coils to "provide latticework for coil deployment" which means I would not report the stent but the provider does not mention that.
What do you think? Please provide rational for your response. Thanks for your help.