jennifer.r.wake
New
I am having some difficulty determining whether to code 36595+75901 or 35476+75978 for the case below (I know the 36581 and 77001 needs to be coded). My understanding is that, even though we are using a balloon to disrupt the fibrin sheath obstruction, we would not be able to code 35476+75978 (angioplasty) unless a stenosis is documented and requires PTA to treat.
Procedures:
After informed consent was obtained, the patient was taken to the interventional suite, and sterilely prepped and draped in the usual fashion. Local anesthesia was provided with 1% Lidocaine with epi. The cuff was bluntly dissected free from the subcutaneous tissues and the enveloping fibrin sheath, and extracted. Guide wire access was obtained into the IVC. An angiogram of the SVC was then completed, demonstrating an obstructive fibrin sheath in the SVC. The sheath obstruction was greater than 60%. 10mm PTA was performed in the SVC to relieve the obstruction. A new 36cm Ash Split catheter was then placed over guide wire and positioned in the right atrium under direct fluoroscopic guidance. Both ports pull and flush easily. The catheter is fixed to the chest wall with 0-Neurolon suture.
Estimated Blood Loss: 5ml
Amount of Radiocontrast used: 10ml
Fluoro time: 1:33 minutes:seconds
Impressions: Successful removal and replacement of left IJ tunneled cuffed dialysis catheter. Fibrin sheath obstruction post PTA of the SVC.
I appreciate any feedback!
Procedures:
After informed consent was obtained, the patient was taken to the interventional suite, and sterilely prepped and draped in the usual fashion. Local anesthesia was provided with 1% Lidocaine with epi. The cuff was bluntly dissected free from the subcutaneous tissues and the enveloping fibrin sheath, and extracted. Guide wire access was obtained into the IVC. An angiogram of the SVC was then completed, demonstrating an obstructive fibrin sheath in the SVC. The sheath obstruction was greater than 60%. 10mm PTA was performed in the SVC to relieve the obstruction. A new 36cm Ash Split catheter was then placed over guide wire and positioned in the right atrium under direct fluoroscopic guidance. Both ports pull and flush easily. The catheter is fixed to the chest wall with 0-Neurolon suture.
Estimated Blood Loss: 5ml
Amount of Radiocontrast used: 10ml
Fluoro time: 1:33 minutes:seconds
Impressions: Successful removal and replacement of left IJ tunneled cuffed dialysis catheter. Fibrin sheath obstruction post PTA of the SVC.
I appreciate any feedback!