Pls confirm the catheter code for the below procedure.
37205
36216
75960-26
75650-26
75605-26
Catheter code should be 36216(brachial) or 36200(aorta)?
Clinical history: Patient is an 82-year-old woman status post
right CVA. Patient is status post inadvertent placement of left
subclavian line into the left subclavian artery.
Procedure:
The patient placed on the angiography table in the supine
position. The right groin was prepped and draped in the usual
sterile fashion. Utilizing a 21-gauge micropuncture needle the
right common femoral artery was entered. Utilizing exchange
techniques a 5-French vascular sheath was placed. An 5 french
Omni flush catheter was advanced over the wire into the ascending
aorta. Digital subtraction angiography of the thoracic aorta was
performed. The right innominate artery was unremarkable in
appearance. The right subclavian and right carotid branch where
unremarkable where visualized. There is a dominant right
vertebral artery. The left common carotid artery is unremarkable
where visualized. The left subclavian artery was demonstrated. A
central line catheter is seen entering into the left subclavian
artery centrally. There is no significant filling of a vertebral
artery. Vascular anatomy of the left subclavian was otherwise
unremarkable. The Omni flush catheter was then exchanged for
headhunter catheter which was used to successfully catheterize the
left subclavian artery. Digital subtraction angiography was
performed of the left subclavian artery. There is no significant
filling of a vertebral artery. The headhunter catheter was
advanced over Glidewire into the brachial artery. The Glidewire
was then exchanged for an exchange length Amplatz wire. The
headhunter catheter was removed over wire. The 5-French vascular
sheath was exchanged for an 8-French vascular sheath. A 7 mm x 4
cm covered stent (Fluency) was then advanced over the wire and
positioned across the entry site of the 7-French central line
catheter into the left subclavian. The central line catheter was
removed and the fluency stent was deployed. Once the fluency was
deployed the headhunter catheter was again advanced over wire into
the subclavian artery. Digital subtraction angiography of the
subclavian artery post deployment was performed. No extravasation
of contrast material was identified. The stent was seen to cross
the proximal subclavian including the region of the entry site of
the prior catheter. The headhunter catheter was exchanged for an
omni-flush catheter which was positioned in the ascending aorta.
Final digital subtraction angiography of aortic arch was
performed. No extravasation of contrast material was identified.
Flow was seen throughout the subclavian artery and beyond the
placement of the stent. The catheter was removed. The sheath was
removed and 25 minutes of manual compression applied until
hemostasis was obtained. The patient tolerated these procedures
well per sterile dressing was applied.
Impression: Successful deployment of 7 mm x 4 cm covered fluency
stent within the subclavian artery covering the entry point of a
7-French central line. Post deployment there was no extravasation
of contrast material. Flow was seen to occur through the lfet
subclavian artery into the brachial artery.
37205
36216
75960-26
75650-26
75605-26
Catheter code should be 36216(brachial) or 36200(aorta)?
Clinical history: Patient is an 82-year-old woman status post
right CVA. Patient is status post inadvertent placement of left
subclavian line into the left subclavian artery.
Procedure:
The patient placed on the angiography table in the supine
position. The right groin was prepped and draped in the usual
sterile fashion. Utilizing a 21-gauge micropuncture needle the
right common femoral artery was entered. Utilizing exchange
techniques a 5-French vascular sheath was placed. An 5 french
Omni flush catheter was advanced over the wire into the ascending
aorta. Digital subtraction angiography of the thoracic aorta was
performed. The right innominate artery was unremarkable in
appearance. The right subclavian and right carotid branch where
unremarkable where visualized. There is a dominant right
vertebral artery. The left common carotid artery is unremarkable
where visualized. The left subclavian artery was demonstrated. A
central line catheter is seen entering into the left subclavian
artery centrally. There is no significant filling of a vertebral
artery. Vascular anatomy of the left subclavian was otherwise
unremarkable. The Omni flush catheter was then exchanged for
headhunter catheter which was used to successfully catheterize the
left subclavian artery. Digital subtraction angiography was
performed of the left subclavian artery. There is no significant
filling of a vertebral artery. The headhunter catheter was
advanced over Glidewire into the brachial artery. The Glidewire
was then exchanged for an exchange length Amplatz wire. The
headhunter catheter was removed over wire. The 5-French vascular
sheath was exchanged for an 8-French vascular sheath. A 7 mm x 4
cm covered stent (Fluency) was then advanced over the wire and
positioned across the entry site of the 7-French central line
catheter into the left subclavian. The central line catheter was
removed and the fluency stent was deployed. Once the fluency was
deployed the headhunter catheter was again advanced over wire into
the subclavian artery. Digital subtraction angiography of the
subclavian artery post deployment was performed. No extravasation
of contrast material was identified. The stent was seen to cross
the proximal subclavian including the region of the entry site of
the prior catheter. The headhunter catheter was exchanged for an
omni-flush catheter which was positioned in the ascending aorta.
Final digital subtraction angiography of aortic arch was
performed. No extravasation of contrast material was identified.
Flow was seen throughout the subclavian artery and beyond the
placement of the stent. The catheter was removed. The sheath was
removed and 25 minutes of manual compression applied until
hemostasis was obtained. The patient tolerated these procedures
well per sterile dressing was applied.
Impression: Successful deployment of 7 mm x 4 cm covered fluency
stent within the subclavian artery covering the entry point of a
7-French central line. Post deployment there was no extravasation
of contrast material. Flow was seen to occur through the lfet
subclavian artery into the brachial artery.