ttglasscock
Contributor
Can I code 36005/75820 with 36010/75827?
PRE-OP DX: CENTRAL VENOUS OCCLUSION WITH RIGHT ARM SWELLING
POST-OP DX:
1. RIGHT INNOMINATE VEIN OCCLUSION
2. LEFT INNOMINATE VEIN OCCLUSION
PROCEDURE:
RIGHT SUBCLAVIAN VEIN VENOGRAM
ATTEMPT AT REVASCULARIZING RIGHT INNOMINATE VEIN OCCLUSION USING STIFF GLIDEWIRE TECHNIQUE
MEDICATIONS: VERSED 2MG, FENTANYL 100MCG
CONTRAST: 20ML
EBL: 5ML
COMPLICATIONS: NONE
TECHNIQUE: Written informed consent obtained. Procedural risks, benefits, and alternatives discussed in detail with patient and all questions answered. Patient placed supine on procedure table and right arm draped in sterile fashion. Right brachial vein accessed using a micropuncture needle and 6 French sheath placed. A 5 French Berenstein catheter advanced into right subclavian vein and venogram demonstrates chronic occlusion of distal right subclavian vein as well as right innominate vein. Multiple attempts at crossing occlusion with stiff glidewire were unsuccessful. The right groin was then draped in sterile fashion. The right common femoral vein was then accessed using a micropuncture needle and 6 French sheath. A 5 French Berenstein catheter was advanced through the sheath and into the SVC. Venogram showed occluded right innominate and left innominate veins. Multiple attempts to cross the occlusion from below were also unsuccessful. Due to length of occlusion, Baylis RF wire is not recommended. Procedure was stopped and sheaths removed and hemostasis obtained using manual compression.
IMPRESSION:
CHRONIC OCCLUSION OF DISTAL RIGHT SUBCLAVIAN VEIN
CHRONIC OCCLUSION OF RIGHT INNOMINATE VEIN
CHRONIC OCCLUSION OF LEFT INNOMINATE VEIN
UNSUCCESSFUL REVASCULARIZATION ATTEMPT USING STIFF GLIDEWIRE. THE USE OF BAYLIS RF WIRE IS PRECLUDED DUE TO LENGTH OF OCCLUSION.
Thank you for referring to the VAC of Bolivar County and allowing us to participate in this patient?s medical care.
Sincerely,
PRE-OP DX: CENTRAL VENOUS OCCLUSION WITH RIGHT ARM SWELLING
POST-OP DX:
1. RIGHT INNOMINATE VEIN OCCLUSION
2. LEFT INNOMINATE VEIN OCCLUSION
PROCEDURE:
RIGHT SUBCLAVIAN VEIN VENOGRAM
ATTEMPT AT REVASCULARIZING RIGHT INNOMINATE VEIN OCCLUSION USING STIFF GLIDEWIRE TECHNIQUE
MEDICATIONS: VERSED 2MG, FENTANYL 100MCG
CONTRAST: 20ML
EBL: 5ML
COMPLICATIONS: NONE
TECHNIQUE: Written informed consent obtained. Procedural risks, benefits, and alternatives discussed in detail with patient and all questions answered. Patient placed supine on procedure table and right arm draped in sterile fashion. Right brachial vein accessed using a micropuncture needle and 6 French sheath placed. A 5 French Berenstein catheter advanced into right subclavian vein and venogram demonstrates chronic occlusion of distal right subclavian vein as well as right innominate vein. Multiple attempts at crossing occlusion with stiff glidewire were unsuccessful. The right groin was then draped in sterile fashion. The right common femoral vein was then accessed using a micropuncture needle and 6 French sheath. A 5 French Berenstein catheter was advanced through the sheath and into the SVC. Venogram showed occluded right innominate and left innominate veins. Multiple attempts to cross the occlusion from below were also unsuccessful. Due to length of occlusion, Baylis RF wire is not recommended. Procedure was stopped and sheaths removed and hemostasis obtained using manual compression.
IMPRESSION:
CHRONIC OCCLUSION OF DISTAL RIGHT SUBCLAVIAN VEIN
CHRONIC OCCLUSION OF RIGHT INNOMINATE VEIN
CHRONIC OCCLUSION OF LEFT INNOMINATE VEIN
UNSUCCESSFUL REVASCULARIZATION ATTEMPT USING STIFF GLIDEWIRE. THE USE OF BAYLIS RF WIRE IS PRECLUDED DUE TO LENGTH OF OCCLUSION.
Thank you for referring to the VAC of Bolivar County and allowing us to participate in this patient?s medical care.
Sincerely,