central venogram w balloon angioplasty of SVC

AgnieszkaMarek

Networker
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66
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Saratoga Springs, NY
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I am only asking for opinion for procedure 1.
I think 36010,75827, 37248 ?

EXAM:
1. Central venogram with balloon angioplasty of the SVC
2. Removal of left-sided portacatheter
3. Implant of new right-sided portacatheter

HISTORY: SVC syndrome
Intravenous conscious sedation was administered by a dedicated
independent observer with continuous hemodynamic and respiratory
monitoring performed, including the use of pulse oximetry.

FINDINGS/TECHNIQUE:

Signed informed consent was obtained from the patient. A time out
procedure was performed.

The patient was placed in the supine position on the stretcher and
the lateral neck and chest extremity prepped and draped in standard
sterile fashion. All elements of maximal sterile barrier technique
were followed including cap and mask, sterile gown, sterile gloves,
large sterile sheet, hand hygiene and 2% chlorhexidine for cutaneous
antisepsis.

Ultrasound of the right neck demonstrated widely patent internal
jugular vein. The skin overlying the targeted entry site was
anesthetized with 10 cc of 1% lidocaine. Using a micropuncture needle
and microcatheter the internal jugular vein was accessed with
fluoroscopic guidance confirming venous access. Contrast injection
through the microcatheter demonstrated occlusion of the SVC with
dilatation and varicosity of the azygos. The inner dilator of the
micropuncture sheath was removed and an 035 Glidewire was advanced to
the IVC.

The micropuncture sheath was exchanged for an 8 French vascular
sheath. The stenotic SVC was angioplastied with a 12 mm x 60 mm
Mustang balloon followed by a 16 x 16 mm Atlas balloon. Follow-up
venography demonstrated significant improvement in the stenosis with
flow no longer seen within the azygos.

Next, attention was turned to making a subcutaneous pocket for new
port insertion on the right. Approximately 3 fingerbreadths below the
midclavicular line a region was infiltrated with 10 cc 1% lidocaine.
An approximately 3 cm incision was made and the pocket was created
using blunt dissection.

Next, the port was assembled and placed into the pocket confirming
adequate sizing. The tunnel tract was anesthetized with 1% lidocaine
and the line was tunneled from the pocket to the venotomy site. The
catheter was measured and cut to the appropriate length. The peel-away
sheath was placed over the 035 wire at the venotomy site under
fluoroscopic guidance. The catheter was placed into the peel-away
sheath and its final position confirmed a single spot image
documenting the tip within the cavoatrial junction.

The catheter was flushed terminally with heparin solution per
protocol.

The subcutaneous pocket was flushed with bacitracin solution. The
pocket was closed with deep 3-0 Vicryl sutures and interrupted
subcutaneous 4-0 Vicryl sutures. Steri-Strips were applied and a
sterile dressing was placed. Steri-Strips were used to close the
venotomy site.

Next, attention was turned to removing the left-sided portacatheter.
The existing portacatheter incision site over the chest was prepped
and draped in standard sterile fashion. All elements of maximal
sterile barrier technique were followed including cap and mask,
sterile gown, sterile gloves, large sterile sheet, hand hygiene and 2%
chlorhexidine for cutaneous antisepsis.

The existing incision area was infiltrated with 1% lidocaine. An
incision was made, the catheter dissected and removed in entirety.
Next, the port housing was removed in entirety after blunt dissection.

The pocket was closed with deep and superficial interrupted sutures.
Steri-Strips and sterile dressing were applied.

The patient tolerated the procedure well without immediate
complication and left the radiology department in stable condition


IMPRESSION:

1. Central/SVC venogram of the stranding chronic occlusion of the SVC
in the midportion immediately adjacent to left sided portacatheter.
36010,75827, 37248 ?

2. Successful angioplasty of the SVC.

3. Removal of left-sided portacatheter.
 

suchang78

Guru
Messages
171
Location
Baldwin Park, CA
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I will only code the angioplasty.
1. venography performed of vessels through same access (port a cath insertion) is bundled into 77001.
2. If performed via separate venous access and separately interpreted, 75820, 75822, 75825, and/or 75827 can be codable.
 

Jim Pawloski

True Blue
Messages
1,390
Location
Ann Arbor
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I would code for this procedure 36561 for the port insertion, 76937 for the ultrasound, 77001 for the fluoro, 37248 for the angioplasty, 36590-59 for the port removal.
HTH,
Jim Pawloski, CIRCC
 

fami

Networker
Messages
67
Location
CULVER CITY CHAPTER
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I would code for this procedure 36561 for the port insertion, 76937 for the ultrasound, 77001 for the fluoro, 37248 for the angioplasty, 36590-59 for the port removal.
HTH,
Jim Pawloski, CIRCC
HI Jim,
I am planning to take CIRCC exam, may I contact you if have questions/ need advise?

Fami Sharif-Pour, B.S-HIA, RHIT, COC, CPC
 
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