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Cuteyr

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Hi,

The report says that
-----------------------------
The RT IJ vein was punctured and sheath was placed in the RT IJ vein and a subcutaneous tunnel was created in the right anterior chest wall with lidocaine and a tunneled cuffed catheter was placed in the subcutaneous tunnel and inserted through the peel-away sheath and both tips were placed at the junction of the SVC and Rt atrium.
The catheter was secured to the skin and both ports were flushed with heparin.

---------------------------------------------------------------------

Please advice and explain if 36561 or 36558 should be coded?

Thanks
 
They aren't placing an implanted port which is 36561. The ports they are flushing are external. Google a tunneled CVC vs a port placement and you can see the difference.
 
Cuteyr said:
But the ports were flushed...
Click to expand...

Here is some more rationale for you: Do not code port placement when documentation states that both ports are injected with heparin at the end of the procedure when the device placed is a tunneled catheter without a subcutaneously buried port type reservoir. Many physicians refer to the limbs of the catheter as the ports. These ports are where a syringe or IV is attached for injection or infusion of medications or fluids and are not coded as true port-a-caths.
 
So this one kind of confuse 36558 or 36561 ?

So this one kind of confuse 36558 or 36561 ?



Indications : ESRD male comes in for permcath placement as patient has no access and needs one for HD needs.

After obtaining written and verbal consent and discussing with patient the risk and benefits of the procedure (not limited to bleeding and infection), patient elected to proceed. The neck and chest area were prepared and draped under the usual standard sterile conditions.

Ultrasound guidance :

The neck veins were evaluated using u/s. It was decided to use the rightt IJ vein for cannulation. The right neck and chest area were prepared and draped under the usual sterile conditions. The right IJ was cannulated just above the clavicle via u/s guidance using micropuncture technique. A 5Fr catheter was inserted over the wire.

Fluoroscopy and contrast evaluation:
About 5mls of contrast was injected that showed the catheter is in the vein. No clots, fibrin sheath or stenosis were noted.
A guidewire was inserted through the 5Fr catheter into the SVC and then into the IVC.

Permcath placement :

Using Fluoroscopy, a guidewire was inserted through the 5Fr sheath into the IVC. The length of the catheter was determined to be 32cm. After determining the exit site using fluoroscopy, the presumed exit site was injected with lidocaine. The presumed tract of the tunnel was also injected with lidocaine. A 0.5cm incision was made in the skin. The entry site was also injected with lidocaine and a 0.5cm incision made at the entry site. The permcath was then tunneled using the tunneling device and brought out through the entry site. After a series of dilatations of the vein, a 15Fr peel away sheath was inserted over the guidewire into the vein. The internal dilator and the guidewire were removed. The permcath was introduced into the peel away sheath while the sheath was peeled away. The tip of the permcath was determined to be at the junction of the SVC and the right atrium.

The entry site was sutured with 3-0 nylon. The ports of the permcath were sealed with sterile caps and flushed with heparinized saline. About 3mls of heparin was also placed into each port. The permcath was secured with 3-0 nylon sutures as well.

The patient tolerated the procedure well and this catheter is ready for immediate use.
 
35lm32 said:
So this one kind of confuse 36558 or 36561 ?



Indications : ESRD male comes in for permcath placement as patient has no access and needs one for HD needs.

After obtaining written and verbal consent and discussing with patient the risk and benefits of the procedure (not limited to bleeding and infection), patient elected to proceed. The neck and chest area were prepared and draped under the usual standard sterile conditions.

Ultrasound guidance :

The neck veins were evaluated using u/s. It was decided to use the rightt IJ vein for cannulation. The right neck and chest area were prepared and draped under the usual sterile conditions. The right IJ was cannulated just above the clavicle via u/s guidance using micropuncture technique. A 5Fr catheter was inserted over the wire.

Fluoroscopy and contrast evaluation:
About 5mls of contrast was injected that showed the catheter is in the vein. No clots, fibrin sheath or stenosis were noted.
A guidewire was inserted through the 5Fr catheter into the SVC and then into the IVC.

Permcath placement :

Using Fluoroscopy, a guidewire was inserted through the 5Fr sheath into the IVC. The length of the catheter was determined to be 32cm. After determining the exit site using fluoroscopy, the presumed exit site was injected with lidocaine. The presumed tract of the tunnel was also injected with lidocaine. A 0.5cm incision was made in the skin. The entry site was also injected with lidocaine and a 0.5cm incision made at the entry site. The permcath was then tunneled using the tunneling device and brought out through the entry site. After a series of dilatations of the vein, a 15Fr peel away sheath was inserted over the guidewire into the vein. The internal dilator and the guidewire were removed. The permcath was introduced into the peel away sheath while the sheath was peeled away. The tip of the permcath was determined to be at the junction of the SVC and the right atrium.

The entry site was sutured with 3-0 nylon. The ports of the permcath were sealed with sterile caps and flushed with heparinized saline. About 3mls of heparin was also placed into each port. The permcath was secured with 3-0 nylon sutures as well.

The patient tolerated the procedure well and this catheter is ready for immediate use.
Click to expand...

This case is a CV catheter w/o port or pump. If the physician saved an image to PACS or placed an image in the chart, 76937 could be billed. But not in this case. 77001 includes the contrast injection. So you code 36558 for the tunneled CV Catheter. Magic words to determine the code is "Permacath" and "hemodialysis".

HTH,
Jim Pawloski, RT (CV), CIRCC
 
How to code an injection using a port?

If a patient comes in to the ER and the Dr. prescribes a non-chemo medicine (Zofran or Fentanyl) for the patient's symptoms, would I still use the normal 96374 and 96375 codes for injections?​
 
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