Kisha
Networker
Hi, I am trying my hand at IVR coding and I need some assistance to see if I'm on the right track here.
I have codes, 36012, 36147, 36512, 35475, 75820
Pre-Operative Diagnosis
1. ESRD
2. Low transonic flows in AVF
Post-Operative Diagnosis
1. ESRD
2. Inflow stenosis reducing flow.
Procedures performed:
1. Cannulation of the arteriovenous access; angiography of the arteriovenous access, draining veins and central venous system up to the right atrium.
2. Selective catheterisation of the proximal radial artery; angiography of the feeding artery and inflow segment of AVF.
3. Percutaneous balloon angioplasty of the radial artery anastamosis. Post-angioplasty angiography with supervision and interpretation.
4. EKG monitoring.
5. Conscious sedation.
Informed Consent:
The procedure, indications, potential complications and available alternatives were explained to the patient. The patient verbalised understanding and agreed to the plan of care. The patient's questions were answered to the patient's satisfaction. Informed consent was obtained.
Time-out: procedure was completed and documented.
Procedure:
The patient was taken to the procedure room, placed in a supine position and placed on continuous blood pressure and cardiac monitoring with oximetry. Supplemental oxygen was provided as needed. The cardiac rhythm was noted to be sinus rhythm and vital signs were stable. Conscious sedation and analgesia was given as needed for patient comfort.
The extremity and surrounding area were prepped and draped in a sterile fashion. Subcutaneous lidocaine 1% was used as a local anaesthetic. The access was entered with a micro-puncture needle in the retrograde direction based on physical examination findings. The 0.018-inch wire was advanced through the needle and fluoroscopically guided into the access. The needle was removed and the micropuncture sheath was advanced into the access over the wire.
A diagnostic angiogram of the access was obtained, including assessment of its draining veins to the superior vena cava and right atrium.
A 0.035-inch glide-wire was navigated fluoroscopically into the access and advanced across the anastamosis into the proximal radial artery. The micropuncture sheath was removed and replaced over the wire with a 6Fr vascualr sheath. A 4Fr imager was navigated over the wire into the proximal radial artery. The wire was removed and aniography performed. The arterial inflow segment, as well as the anastamosis and feeding artery were evaluated. The lesions within the circuit were noted and documented.
Findings:
1. Left UE radial artery to cephalic vein AVF.
2. Radial artery anastamosis stenosis 80%.
3. evidence of previous infiltration of access in area of buttonholes.
4. Patent remaining fistula and outflow.
5. Central veins: patent.
The wire was replaced through the imager and the imager was removed from over the wire. A 4mmx2cm Mustang angioplasty balloon was passed over the wire and advanced to fluoroscopically to be positioned over anastamosis. Angioplasty was performed using an inflation device and the balloon was inflated slowly to 20 atm. Balloon waist was noted, followed by full effacement. Post angioplasty angiography was performed with the imager. No acute complications of the angioplasty were noted. Residual recoil lesion was noted 40%.
The wire was replaced through the imager and the imager was removed from over the wire. A 5mmx2cm Mustang angioplasty balloon was passed over the wire and advanced to fluoroscopically to be positioned over anastamosis. Angioplasty was performed using an inflation device and the balloon was inflated slowly to 10 atm. Balloon waist was noted, followed by full effacement. Post angioplasty angiography was performed with the imager. There was no residual lesion noted and no complications were seen. The result of the angioplasty considered satisfactory.
The balloon, wire and sheath were removed and the puncture site was closed with a prolene suture. Hemostasis was achieved.
I have codes, 36012, 36147, 36512, 35475, 75820
Pre-Operative Diagnosis
1. ESRD
2. Low transonic flows in AVF
Post-Operative Diagnosis
1. ESRD
2. Inflow stenosis reducing flow.
Procedures performed:
1. Cannulation of the arteriovenous access; angiography of the arteriovenous access, draining veins and central venous system up to the right atrium.
2. Selective catheterisation of the proximal radial artery; angiography of the feeding artery and inflow segment of AVF.
3. Percutaneous balloon angioplasty of the radial artery anastamosis. Post-angioplasty angiography with supervision and interpretation.
4. EKG monitoring.
5. Conscious sedation.
Informed Consent:
The procedure, indications, potential complications and available alternatives were explained to the patient. The patient verbalised understanding and agreed to the plan of care. The patient's questions were answered to the patient's satisfaction. Informed consent was obtained.
Time-out: procedure was completed and documented.
Procedure:
The patient was taken to the procedure room, placed in a supine position and placed on continuous blood pressure and cardiac monitoring with oximetry. Supplemental oxygen was provided as needed. The cardiac rhythm was noted to be sinus rhythm and vital signs were stable. Conscious sedation and analgesia was given as needed for patient comfort.
The extremity and surrounding area were prepped and draped in a sterile fashion. Subcutaneous lidocaine 1% was used as a local anaesthetic. The access was entered with a micro-puncture needle in the retrograde direction based on physical examination findings. The 0.018-inch wire was advanced through the needle and fluoroscopically guided into the access. The needle was removed and the micropuncture sheath was advanced into the access over the wire.
A diagnostic angiogram of the access was obtained, including assessment of its draining veins to the superior vena cava and right atrium.
A 0.035-inch glide-wire was navigated fluoroscopically into the access and advanced across the anastamosis into the proximal radial artery. The micropuncture sheath was removed and replaced over the wire with a 6Fr vascualr sheath. A 4Fr imager was navigated over the wire into the proximal radial artery. The wire was removed and aniography performed. The arterial inflow segment, as well as the anastamosis and feeding artery were evaluated. The lesions within the circuit were noted and documented.
Findings:
1. Left UE radial artery to cephalic vein AVF.
2. Radial artery anastamosis stenosis 80%.
3. evidence of previous infiltration of access in area of buttonholes.
4. Patent remaining fistula and outflow.
5. Central veins: patent.
The wire was replaced through the imager and the imager was removed from over the wire. A 4mmx2cm Mustang angioplasty balloon was passed over the wire and advanced to fluoroscopically to be positioned over anastamosis. Angioplasty was performed using an inflation device and the balloon was inflated slowly to 20 atm. Balloon waist was noted, followed by full effacement. Post angioplasty angiography was performed with the imager. No acute complications of the angioplasty were noted. Residual recoil lesion was noted 40%.
The wire was replaced through the imager and the imager was removed from over the wire. A 5mmx2cm Mustang angioplasty balloon was passed over the wire and advanced to fluoroscopically to be positioned over anastamosis. Angioplasty was performed using an inflation device and the balloon was inflated slowly to 10 atm. Balloon waist was noted, followed by full effacement. Post angioplasty angiography was performed with the imager. There was no residual lesion noted and no complications were seen. The result of the angioplasty considered satisfactory.
The balloon, wire and sheath were removed and the puncture site was closed with a prolene suture. Hemostasis was achieved.