37215?

daniel

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Hello ALL
A physician performs Ultrasound-guided access of right common femoral artery with Stenting of right common carotid artery and Removal of right portacath. How is this coded?



OPERATIVE PROCEDURE IN DETAIL: After appropriate consent was obtained and timeout performed, the patient was prepped and draped in the usual sterile fashion. Ultrasound was used for right common femoral arterial access and placement confirmed with fluoroscopy. A wire was advanced into the aorta and catheter advanced into the arch. Using an angled glide wire and glide cath, the right innominate and then subclavian was selected. A stiff wire was advanced down the subclavian and into the brachial artery under direct visualization and a 7Fr x 90cm Ansel sheath was advanced into the innominate. We had been giving heparin since the start of the procedure in compliance with neurology stipulations. With the sheath in the innominate, angiograms were obtained and the exact location of the port entrance was identified. An 8L x 29mm VBX stent was advanced with some difficulty through the sheath and positioned across the area of injury. Cutdown and angiogram was taken through the port for confirmation of positioning. The stent was deployed and the port removed. Angiogram demonstrated a small leak, so the stent was post-dilated with a 9mm balloon. Completion angiography demonstrated good seal, brisk flow into both the carotid and subclavian with no further extravasation. All wires and catheters were removed. A proglide was attempted in the R CFA but was unsuccessful so pressure was held for control. There were baseline pulses distally at the conclusion of the case. The portacath was dissected free from the pocket and after hemostasis was achieved the port pocket was closed in layers. Sterile dressings were applied. The patient emerged from anesthesia at baseline neuro status, moving the R side, following commands.
 

arclayton

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Hi Daniel! I thought I would throw in my 2 cents:

First, the stent code 37215 would be inappropriate for a couple reasons. This code refers to the cervical carotid artery and we are in the thoracic region. Also, percutaneous cervical carotid artery stent placement is used in place of carotid endarterectomy for patients who have high-risk conditions. The physician doesn’t mention any plaque, so I know this isn’t the case with your patient.

I was confused as to why we were in the arteries for a Central Venous Cath removal. I suspect the port was compressing the innominate artery. If that is the case, then we would report 37236, 36200 (the catheter only reached the aortic arch and did not go into the innominate).

The portacath removal would be reported with 36590.
 
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