iamlou
Networker
How would you code this? Pt. needed a PICC line but had an occlusion in the vein, so Dr. did an angioplasty of the subclavian vein and then put the PICC in. Would you code the angioplasty in addition to the PICC insertion
(35476/75978/36569), and if so, would you omit the fluoroscopy (77001) since 75978 is being coded?
PROCEDURES PERFORMED:
Ultrasound and radiologically guided insertion of right upper extremity
triple-lumen PICC line insertion, right subclavian venogram and balloon
angioplasty
IMAGING MODALITY UTILIZED:
Ultrasound and fluoroscopy
ANESTHESIA: Local.
ACCESS SITE:
Right deep brachial vein above the elbow
CATHETER POSITION:
PICC line catheter tip position in the distal SVC
TECHNIQUE: Under ultrasound guidance, after achieving local anesthesia with 1 percent lidocaine, the right deep brachial vein was accessed above the elbow. A 5 French micropuncture catheter was inserted. Central venogram was performed. There is a short segmental occlusion of the right subclavian vein, bridged by the right external jugular and internal jugular veins.
Initial attempt at passage of the 0.018 inch PICC guidewire was
unsuccessful. As such, a 5 French sheath was inserted. A 0.035 inch
quick cross catheter was advanced over a 0.035 inch Glidewire into the SVC.
The Glidewire was removed. Through the quick cross catheter 0.014 inch
Cordis XS wire was placed. The right subclavian vein was subsequently
dilated with a 4 mm x 40 mm Sterling balloon. Subsequently over the
guidewire the 5 French sheath was exchanged for a 6 French peel-away
sheath. Through the peel-away sheath a 6 French triple lumen PICC line was
inserted. The cut length is 46 cm, the external length is none. Sterile
dressing applied. Tip position at the level of the distal SVC.
FINDINGS:
Patent right deep brachial, axillary vein. Occluded central right
subclavian vein bridged by right external jugular to internal jugular vein
collateral. Patent SVC. Right subclavian dual-lead pacemaker.
Thanks for your assistance!
(35476/75978/36569), and if so, would you omit the fluoroscopy (77001) since 75978 is being coded?
PROCEDURES PERFORMED:
Ultrasound and radiologically guided insertion of right upper extremity
triple-lumen PICC line insertion, right subclavian venogram and balloon
angioplasty
IMAGING MODALITY UTILIZED:
Ultrasound and fluoroscopy
ANESTHESIA: Local.
ACCESS SITE:
Right deep brachial vein above the elbow
CATHETER POSITION:
PICC line catheter tip position in the distal SVC
TECHNIQUE: Under ultrasound guidance, after achieving local anesthesia with 1 percent lidocaine, the right deep brachial vein was accessed above the elbow. A 5 French micropuncture catheter was inserted. Central venogram was performed. There is a short segmental occlusion of the right subclavian vein, bridged by the right external jugular and internal jugular veins.
Initial attempt at passage of the 0.018 inch PICC guidewire was
unsuccessful. As such, a 5 French sheath was inserted. A 0.035 inch
quick cross catheter was advanced over a 0.035 inch Glidewire into the SVC.
The Glidewire was removed. Through the quick cross catheter 0.014 inch
Cordis XS wire was placed. The right subclavian vein was subsequently
dilated with a 4 mm x 40 mm Sterling balloon. Subsequently over the
guidewire the 5 French sheath was exchanged for a 6 French peel-away
sheath. Through the peel-away sheath a 6 French triple lumen PICC line was
inserted. The cut length is 46 cm, the external length is none. Sterile
dressing applied. Tip position at the level of the distal SVC.
FINDINGS:
Patent right deep brachial, axillary vein. Occluded central right
subclavian vein bridged by right external jugular to internal jugular vein
collateral. Patent SVC. Right subclavian dual-lead pacemaker.
Thanks for your assistance!