endrest
Contributor
Need help, how would you code this op note? With placement of 2 Unifuse Catheters.
I'm looking at 36247, 37211, 75625, 75710 - but not 100% sure. Any one -please help.
NAME OF OPERATION/PROCEDURE:
1. Ultrasound-guided access left femoral popliteal graft with thrombolysis a Unifuse catheter placement right limb of occluded aortobifemoral graft, using a 90 cm, 30 cm infusion length thrombolysis catheter
2. A second criss-cross catheter of the same right fem-pop graft.
3. Ultrasound guided access with placement of a 90 cm to 40 cm treatment length along the entire length of the graft to the popliteal artery.
4. Injection of thrombolysis on end of catheter 1 mg into the tibial vessels, 2 mg into the iliac vessels, 1 mg into the fem-pop graft
ltrasound access was utilized with an 18-gauge needle and a 0.035 Storq wire was readily navigated from the right proximal fem-pop graft, which connected into the distal limb of the aortobifemoral graft and the wire could be seen extending up the graft. A 5-French sheath was utilized for entrance. The small sheath again confirmed that we were indeed within the graft and a 65 cm 4-French slip cath was placed within the aorta. Puff injection was performed to confirm that there is no occlusions of the aorta or changes since our prior imaging studies. At this juncture, a Uni-Fuse catheter was placed, 40 cm treatment length on a 90 cm shaft and was positioned in the distal aorta and extending into the graft. At this juncture, ultrasound access was then used in an anterograde fashion to access the fem-pop graft. The distal third of the leg, and the 0.035 Storq wire readily navigated into the popliteal artery. I placed a 5-French sheath and hand injection confirmed that we were within the graft. At this point, the 4-French slip cath was introduced into the popliteal artery, and injection of tibial vessels noted clot burden within the length of the popliteal artery. There was sparing of the distal 1 cm for the trifurcation. The trifurcation was patent; however, the flow was sluggish from the mid tibial distally consistent with clot burden in the distal tibial vessels. The ankle shot
noted the anterior tibial and posterior tibial vessels did crossed the ankle, but minimal flow could be seen in the foot consistent with clot disease burden within the foot. At this juncture in a 40 cm treatment length on a 9 cm length, Uni-Fuse catheter was introduced in the popliteal artery. The inner wires were placed in each of these catheters. The iliac artery was pulsed with 2 mg of alteplase. Prior to placing the distal Uni-Fuse catheter
through the slip cath, 1 mg of alteplase utilized to perfuse the tibial vessels, followed by a second mg to lase the clot within the fem-pop graft after the Unifuse catheter had been placed.
Thanks for any help!
Tammy
endrest@health.missouri.edu
I'm looking at 36247, 37211, 75625, 75710 - but not 100% sure. Any one -please help.
NAME OF OPERATION/PROCEDURE:
1. Ultrasound-guided access left femoral popliteal graft with thrombolysis a Unifuse catheter placement right limb of occluded aortobifemoral graft, using a 90 cm, 30 cm infusion length thrombolysis catheter
2. A second criss-cross catheter of the same right fem-pop graft.
3. Ultrasound guided access with placement of a 90 cm to 40 cm treatment length along the entire length of the graft to the popliteal artery.
4. Injection of thrombolysis on end of catheter 1 mg into the tibial vessels, 2 mg into the iliac vessels, 1 mg into the fem-pop graft
ltrasound access was utilized with an 18-gauge needle and a 0.035 Storq wire was readily navigated from the right proximal fem-pop graft, which connected into the distal limb of the aortobifemoral graft and the wire could be seen extending up the graft. A 5-French sheath was utilized for entrance. The small sheath again confirmed that we were indeed within the graft and a 65 cm 4-French slip cath was placed within the aorta. Puff injection was performed to confirm that there is no occlusions of the aorta or changes since our prior imaging studies. At this juncture, a Uni-Fuse catheter was placed, 40 cm treatment length on a 90 cm shaft and was positioned in the distal aorta and extending into the graft. At this juncture, ultrasound access was then used in an anterograde fashion to access the fem-pop graft. The distal third of the leg, and the 0.035 Storq wire readily navigated into the popliteal artery. I placed a 5-French sheath and hand injection confirmed that we were within the graft. At this point, the 4-French slip cath was introduced into the popliteal artery, and injection of tibial vessels noted clot burden within the length of the popliteal artery. There was sparing of the distal 1 cm for the trifurcation. The trifurcation was patent; however, the flow was sluggish from the mid tibial distally consistent with clot burden in the distal tibial vessels. The ankle shot
noted the anterior tibial and posterior tibial vessels did crossed the ankle, but minimal flow could be seen in the foot consistent with clot disease burden within the foot. At this juncture in a 40 cm treatment length on a 9 cm length, Uni-Fuse catheter was introduced in the popliteal artery. The inner wires were placed in each of these catheters. The iliac artery was pulsed with 2 mg of alteplase. Prior to placing the distal Uni-Fuse catheter
through the slip cath, 1 mg of alteplase utilized to perfuse the tibial vessels, followed by a second mg to lase the clot within the fem-pop graft after the Unifuse catheter had been placed.
Thanks for any help!
Tammy
endrest@health.missouri.edu