Appropriate coding for IVC Filter

she803

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The physician coded the below report as cpt 36010, 37620, 75825, 75940 and 76937--however cpt 76937 is an add on code--how should this report be coded accordingly? Thank you.

History: The patient is a 89 year old female requiring prophylaxis for pulmonary embolism. Patient is planned for certain elective orthopedic surgery.

Indication: Prophylaxis against PE in patient unable to undergo anticoagulation.

Sedation: 1% lidocaine

Approach: left common femoral, sonographic and fluoroscopic guided

Contrast: 20 cc Omniscan

Fluoro time: 2 minutes

Procedure time: 30 minutes

Immediate complications: None

Procedure: Continuous physiological monitoring was performed throughout the procedure. With the patient in the supine position the left groin was prepped and draped in usual sterile fashion. Under ultrasound guidance left common femoral vein was catheterized using 21G needle. Exchange was made for 4 French angiographic catheter which was then successfully passed into the inferior vena cava. Exchange was made for a IVC filter introducer sheath. Contrast examination shows normal-sized patent inferior vena cava.The position of the renal veins was noted. A removable Gunther Tulip IVC filter was than deployed at L3 level with good positioning. The sheath was removed and manual pressure was applied to the puncture site until adequate hemostasis was achieved. The patient tolerated the procedure without incident.

Conclusion :

1/ IVC gram performed via left common femoral vein vein demonstrating a patent IVC was no thrombus.
2/ Successful deployment of the removable Gunther Tulip IVC filter at L3 level.
 

Jim Pawloski

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The physician coded the below report as cpt 36010, 37620, 75825, 75940 and 76937--however cpt 76937 is an add on code--how should this report be coded accordingly? Thank you.

History: The patient is a 89 year old female requiring prophylaxis for pulmonary embolism. Patient is planned for certain elective orthopedic surgery.

Indication: Prophylaxis against PE in patient unable to undergo anticoagulation.

Sedation: 1% lidocaine

Approach: left common femoral, sonographic and fluoroscopic guided

Contrast: 20 cc Omniscan

Fluoro time: 2 minutes

Procedure time: 30 minutes

Immediate complications: None

Procedure: Continuous physiological monitoring was performed throughout the procedure. With the patient in the supine position the left groin was prepped and draped in usual sterile fashion. Under ultrasound guidance left common femoral vein was catheterized using 21G needle. Exchange was made for 4 French angiographic catheter which was then successfully passed into the inferior vena cava. Exchange was made for a IVC filter introducer sheath. Contrast examination shows normal-sized patent inferior vena cava.The position of the renal veins was noted. A removable Gunther Tulip IVC filter was than deployed at L3 level with good positioning. The sheath was removed and manual pressure was applied to the puncture site until adequate hemostasis was achieved. The patient tolerated the procedure without incident.

Conclusion :

1/ IVC gram performed via left common femoral vein vein demonstrating a patent IVC was no thrombus.
2/ Successful deployment of the removable Gunther Tulip IVC filter at L3 level.
How about 37191. It includes everything, catheter placement, all imaging, and filter placement. It a new code.
Jim Pawloski, R.T. (CV), CIRCC:)
 
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