balloon angioplasty with pelvic venography

AgnieszkaMarek

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Messages
71
Location
Saratoga Springs, New York
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PREOPERATIVE DIAGNOSIS:
Left back/pelvic pain

POSTOPERATIVE DIAGNOSIS:
Severe left common iliac compression.
Significant left gonadal vein reflux.


PROCEDURE NAME:
Ultrasound fluoroscopy guided right common femoral vein access, and
left great saphenous vein access.
Bilateral pelvic venography.
Left common iliac vein intravenous ultrasound, pressure measurement.
Bilateral renal vein venography, left renal vein pressure measurement,
and left renal vein balloon angioplasty.
Selective left gonadal vein angiography.

ANESTHESIA: Intravenous conscious sedation was administered by cath
lab nursing. Continuous hemodynamic and respiratory monitoring was
performed, including the use of pulse oximetry.


Using ultrasound and fluoroscopic guidance, the right common femoral
vein was accessed. A 6 French vascular sheath was placed.

In similar fashion, left great saphenous vein was accessed. A 8 French
vascular sheath place.

Bilateral venography was performed, which demonstrate patent right
iliac veins. Severe focal stenosis of the left common iliac with
significant cross pelvic collaterals suggest hemodynamic significance.
Next, intravascular ultrasound was performed, which confirmed
angiographic findings.

Next, a cobra 2 catheter was used to select the right renal vein, and
the left renal vein. Selective venography was performed. Patent right
renal vein. Patent left renal vein. Significant reflux of contrast via
the left gonadal vein into the pelvis with associated pelvic
collaterals. Next, the left ovarian vein was selected followed by
superselective angiography, which confirmed finding.

Next, left renal vein and IVC pressure was measured, no pressure
gradient. Next, 10 mm balloon was insufflated into 2ATM, no waist
identified to suggest severe stenosis.

Sheaths and wires were removed and hemostasis was achieved with manual
compression.

The patient tolerated the procedure well and there were no immediate
competitions.


IMPRESSION:
Ultrasound fluoroscopy guided right common femoral vein access, and
left great saphenous vein access. Venotomy closure with manual
compression.
Bilateral pelvic venography. Severe stenosis of the left common iliac
vein, significant cross pelvic collaterals. Patent left pelvic vein.
Left common iliac vein intravenous ultrasound, pressure measurement.
Pressure gradient of 2. Significant focal stenosis of the left common
iliac vein between the right common iliac artery and spine.
Bilateral renal vein venography, left renal vein pressure measurement,
and left renal vein balloon angioplasty. No significant left renal
vein stenosis. No pressure gradient between the left renal vein and
IVC. Low pressure balloon inflation to 10 mm. No waist identified.
Selective left gonadal vein angiography. Enlarged left gonadal vein.
Significant reflux of contrast towards the pelvis with associated
pelvic varices.

37248, 36011.36012-59,75833,75840
 

mk2001

Networker
Messages
91
Best answers
0
PREOPERATIVE DIAGNOSIS:
Left back/pelvic pain

POSTOPERATIVE DIAGNOSIS:
Severe left common iliac compression.
Significant left gonadal vein reflux.


PROCEDURE NAME:
Ultrasound fluoroscopy guided right common femoral vein access, and
left great saphenous vein access.
Bilateral pelvic venography.
Left common iliac vein intravenous ultrasound, pressure measurement.
Bilateral renal vein venography, left renal vein pressure measurement,
and left renal vein balloon angioplasty.
Selective left gonadal vein angiography.

ANESTHESIA: Intravenous conscious sedation was administered by cath
lab nursing. Continuous hemodynamic and respiratory monitoring was
performed, including the use of pulse oximetry.


Using ultrasound and fluoroscopic guidance, the right common femoral
vein was accessed. A 6 French vascular sheath was placed.

In similar fashion, left great saphenous vein was accessed. A 8 French
vascular sheath place.

Bilateral venography was performed, which demonstrate patent right
iliac veins. Severe focal stenosis of the left common iliac with
significant cross pelvic collaterals suggest hemodynamic significance.
Next, intravascular ultrasound was performed, which confirmed
angiographic findings.

Next, a cobra 2 catheter was used to select the right renal vein, and
the left renal vein. Selective venography was performed. Patent right
renal vein. Patent left renal vein. Significant reflux of contrast via
the left gonadal vein into the pelvis with associated pelvic
collaterals. Next, the left ovarian vein was selected followed by
superselective angiography, which confirmed finding.

Next, left renal vein and IVC pressure was measured, no pressure
gradient. Next, 10 mm balloon was insufflated into 2ATM, no waist
identified to suggest severe stenosis.

Sheaths and wires were removed and hemostasis was achieved with manual
compression.

The patient tolerated the procedure well and there were no immediate
competitions.


IMPRESSION:
Ultrasound fluoroscopy guided right common femoral vein access, and
left great saphenous vein access. Venotomy closure with manual
compression.
Bilateral pelvic venography. Severe stenosis of the left common iliac
vein, significant cross pelvic collaterals. Patent left pelvic vein.
Left common iliac vein intravenous ultrasound, pressure measurement.
Pressure gradient of 2. Significant focal stenosis of the left common
iliac vein between the right common iliac artery and spine.
Bilateral renal vein venography, left renal vein pressure measurement,
and left renal vein balloon angioplasty. No significant left renal
vein stenosis. No pressure gradient between the left renal vein and
IVC. Low pressure balloon inflation to 10 mm. No waist identified.
Selective left gonadal vein angiography. Enlarged left gonadal vein.
Significant reflux of contrast towards the pelvis with associated
pelvic varices.

37248, 36011.36012-59,75833,75840
I know this is way late but I was wondering if 75822 & 37252 could have been billed and what 75840 was billed for.
 
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