margaret fahy
Guru
03/03/15
Hi Guys,
For procedure below, I want to be sure I'm coding properly for the Venograms and catheter insertion.
Is it 36005/75820 and then the 37211? The venograms are confusing me, as he went to the axillary vein and then across the subclavian and a pullback venogram was done....
Need to get the correct venogram codes.
Thanks so much.
The patient was placed supine on the x-ray table and an
ultrasound of the right brachial vein was performed to confirm
patency. A suitable skin site was marked. The right upper arm
was prepared and draped in the usual sterile fashion. Using
ultrasound guidance a 21 gauge needle puncture needle was
advanced into the right brachial vein and once blood return was
obtained an 0.018 Mandril wire was advanced under fluoroscopic
guidance. A 4 French micropuncture sheath was then inserted and
0.018 inch Mandril was exchanged for a 0.035 inch Glidewire and a
6F vascular sheath was placed. Using a JB-1 catheter and the
glidewire the catheter was manipulated into the right axillary
vein and contrast was injected demonstrating thrombus narrowing
the right axillary vein as well as occlusive thrombosis of the
right subclavian vein. Collateralization is sparse. Using 5
French Kumpe catheter and the glidewire, the catheter was then
manipulated across the right subclavian vein occlusion and a
pullback venogram was performed demonstrating normally patent SVC
and right innominate vein with the distal end of the thrombus
extending 10 cm from the medial third of the right subclavian
vein to the medial third of the right axillary vein. A 5F 10 cm
thrombolysis catheter was inserted, extended across the areas of
thrombus and secured to the sheath. A continuous infusion of 1
mg/hour TPA was initiated in the IR suite.
Permanent fluoroscopic images were obtained and stored in the
PACS system.
IMPRESSION
Successful placement of right 5 French 10 cm
thrombolysis catheter across right axillo-subclavian thrombus.
PLAN: The patient will be observed overnight in the ICU. TPA will
be infused through the lysis catheter at a rate of 1 mg/hr. The
patient will also be systemically anticoagulated using heparin to
maintain a PTT of 60-80. The patient will return tomorrow for
follow-up venogram, possible angioplasty and possible further
thrombolysis.
Hi Guys,
For procedure below, I want to be sure I'm coding properly for the Venograms and catheter insertion.
Is it 36005/75820 and then the 37211? The venograms are confusing me, as he went to the axillary vein and then across the subclavian and a pullback venogram was done....
Need to get the correct venogram codes.
Thanks so much.
The patient was placed supine on the x-ray table and an
ultrasound of the right brachial vein was performed to confirm
patency. A suitable skin site was marked. The right upper arm
was prepared and draped in the usual sterile fashion. Using
ultrasound guidance a 21 gauge needle puncture needle was
advanced into the right brachial vein and once blood return was
obtained an 0.018 Mandril wire was advanced under fluoroscopic
guidance. A 4 French micropuncture sheath was then inserted and
0.018 inch Mandril was exchanged for a 0.035 inch Glidewire and a
6F vascular sheath was placed. Using a JB-1 catheter and the
glidewire the catheter was manipulated into the right axillary
vein and contrast was injected demonstrating thrombus narrowing
the right axillary vein as well as occlusive thrombosis of the
right subclavian vein. Collateralization is sparse. Using 5
French Kumpe catheter and the glidewire, the catheter was then
manipulated across the right subclavian vein occlusion and a
pullback venogram was performed demonstrating normally patent SVC
and right innominate vein with the distal end of the thrombus
extending 10 cm from the medial third of the right subclavian
vein to the medial third of the right axillary vein. A 5F 10 cm
thrombolysis catheter was inserted, extended across the areas of
thrombus and secured to the sheath. A continuous infusion of 1
mg/hour TPA was initiated in the IR suite.
Permanent fluoroscopic images were obtained and stored in the
PACS system.
IMPRESSION
Successful placement of right 5 French 10 cm
thrombolysis catheter across right axillo-subclavian thrombus.
PLAN: The patient will be observed overnight in the ICU. TPA will
be infused through the lysis catheter at a rate of 1 mg/hr. The
patient will also be systemically anticoagulated using heparin to
maintain a PTT of 60-80. The patient will return tomorrow for
follow-up venogram, possible angioplasty and possible further
thrombolysis.