Shirleybala
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Hello:
Can we code 37187 with 37201 for the below documentation:
37187
37201 59
36011
75820 26
75896 26
The patient's right arm was prepped and draped in usual sterile
manner and locally anesthetized with 1% lidocaine. Under
real-time ultrasound guidance the right brachial vein was accessed
with a micropuncture set. An image was stored for the medical
record.
Using Seldinger technique a 6-French vascular sheath was placed.
A 4-French Berenstein catheter was then advanced into the
subclavian vein. Contrast was injected and digital subtraction
venography was performed.
Findings:
There is a 2.5-cm long occlusion of the right subclavian vein,
extending to the level of the confluence with the right
brachiocephalic vein. There are numerous enlarged collateral
veins present.
Intervention:
Under digital roadmap guidance the occlusion was successfully
crossed with a Berenstein catheter and angled Glidewire. The
Possis AngioJet device was utilized using power pulse technique.
5 mg TPA was mixed in 20 cc normal saline, which was laced across
the thrombus with the outflow valve closed.
The TPA was allowed to sit in the clot for one hour, and then the
Possis AngioJet was used in the normal isovolumetric manner with
the outflow opened, using heparinized saline. After several
passes patency was successfully reestablished. Completion
angiography was performed with the patient's arm at his side,
demonstrating debulking of the vast majority of thrombus. There
is still a moderate to severe stenosis in the right subclavian
vein, consistent with thoracic outlet syndrome.
At the end of the procedure and the vascular sheath was removed
and hemostasis achieved with manual compression. The patient
tolerated the procedure well, left the department in stable
condition. He was noted to have red colored urine, consistent
with hemoglobinuria and hemolysis related to the Possis AngioJet
device.
Impression:
2.5-cm long occlusion right subclavian vein. Successful
mechanical and pharmacologic thrombolysis using the Possis
AngioJet and 5 mg TPA. No immediate complications. Red colored
urine secondary to hemolysis and hemoglobinuria, a known
phenomenon with the Possis AngioJet.
Can we code 37187 with 37201 for the below documentation:
37187
37201 59
36011
75820 26
75896 26
The patient's right arm was prepped and draped in usual sterile
manner and locally anesthetized with 1% lidocaine. Under
real-time ultrasound guidance the right brachial vein was accessed
with a micropuncture set. An image was stored for the medical
record.
Using Seldinger technique a 6-French vascular sheath was placed.
A 4-French Berenstein catheter was then advanced into the
subclavian vein. Contrast was injected and digital subtraction
venography was performed.
Findings:
There is a 2.5-cm long occlusion of the right subclavian vein,
extending to the level of the confluence with the right
brachiocephalic vein. There are numerous enlarged collateral
veins present.
Intervention:
Under digital roadmap guidance the occlusion was successfully
crossed with a Berenstein catheter and angled Glidewire. The
Possis AngioJet device was utilized using power pulse technique.
5 mg TPA was mixed in 20 cc normal saline, which was laced across
the thrombus with the outflow valve closed.
The TPA was allowed to sit in the clot for one hour, and then the
Possis AngioJet was used in the normal isovolumetric manner with
the outflow opened, using heparinized saline. After several
passes patency was successfully reestablished. Completion
angiography was performed with the patient's arm at his side,
demonstrating debulking of the vast majority of thrombus. There
is still a moderate to severe stenosis in the right subclavian
vein, consistent with thoracic outlet syndrome.
At the end of the procedure and the vascular sheath was removed
and hemostasis achieved with manual compression. The patient
tolerated the procedure well, left the department in stable
condition. He was noted to have red colored urine, consistent
with hemoglobinuria and hemolysis related to the Possis AngioJet
device.
Impression:
2.5-cm long occlusion right subclavian vein. Successful
mechanical and pharmacologic thrombolysis using the Possis
AngioJet and 5 mg TPA. No immediate complications. Red colored
urine secondary to hemolysis and hemoglobinuria, a known
phenomenon with the Possis AngioJet.