Procedure #1:
preop diag: bacteremia with line sepsis
postop diag: bacteremia with line sepsis with ESRD requiring hemodialysis
Ultrasound guidance was used to isolate the internal jugular vein, and under us guidance, the internal jugular was cannulated. A J-wire was placed under fluoroscopic guidance through the jugular vein and into the superior vena cava junction. This was followed by appropriate dilatation, and in the Seidinger technique the catheter was placed. Radiographic findings revealed no pneumothorax s/p line placement. On ultrasound guidance, the left internal jugular was of excellent caliber without obvious stricture.
I would code this 36556/77001, (73967 if permanent image was taken)
Procedure #2:
Procedure: Exchange of left internal jugular temporary hemodialysis catheter for insertion of left internal jugular Perma-Cath placement under fluoroscopic guidance.
Initially local was injected in the tunnel area. A counter-incision was made over her left anterior chest wall. The Permacath device was tunnelled through this area to the opening of the old internal jugular catheter. A wire was placed through the old internal jugular catheter to the inferior vena cava. The old catheter was removed. The dilator and pull-away sheath was inserted in the Seidinger fashion in the right internal jugular. The wire was removed and the permacath was now inserted through this pullaway sheath. The sheath was removed. This was all done under fluoroscopic guidance.