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Central venous acess

Shirleybala

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Hi,
How to code this senario.
Preliminary ultrasound demonstrates irregularity of the left
internal and external jugular veins. The left neck was then
prepped and draped in the usual sterile manner and locally
anesthetized with two percent lidocaine. Under ultrasound
guidance, the left internal jugular vein was accessed with a
micropuncture set.
The microwire would not advance below the
level of the clavicle. Subsequently, limited venography through
the needle was performed, demonstrating an occluded left internal
jugular vein with abnormal, tortuous collateral vessels at the
base of the left neck.

Subsequently, the left external jugular vein was punctured with a
21-gauge needle A permanent recording was created for the
patient's record. The
microwire would not advance through the

needle. Subsequently, limited venography was performed,
demonstrating an occluded left external jugular vein. The left
neck access was then aborted.

Limited ultrasound of the right common femoral vein was then
performed, demonstrating a widely patent and freely compressible
vein. Subsequently, the right groin was prepped and draped in
usual sterile fashion. 1% lidocaine was administered for local
anesthesia. Under real-time sonographic guidance, a 21-gauge
needle was advanced into the right common femoral vein
. A
sonographic recording was created for the patient's record.
Exchange was made for a micropuncture set. The tract was then
dilated over a guidewire, and a 24 cm long Schon XL non-tunneled
dialysis catheter was placed, catheter tip in the inferior vena
cava. Good bidirectional flow was noted from both lumens, which
were locked with heparin solution. The catheter was sutured in
place with prolene and a sterile dressing applied. The patient
tolerated the procedure well, and left the department in stable
condition.
 

Shirleybala

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suggestion

Hi mindys please give your suggestion for the above senario

Thanks
Shirley CPC, CPC-H
 

MLS2

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I was looking at 75860 for the jugular venograms. (possibly add a 52 mod since it says limited venogram??)
36005-59x2 for both punctures (internal jug. and external jug.)
76937 for the US recording and 36556 for the central line.

I'm not sure what your dx code is for the cath. placement, but use that for the central line and the occlusion of the veins for the venography.

Those are my thoughts:)
 

Shirleybala

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IJV(internal jugular vein)

For IJV puncture 36010 should be used , It is given in Med lern (IR manul from AMA)
 

MLS2

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an ipsilateral internal jugular vein puncture is 36005 per the Interventional Radiology Coder. These were direct punctures of each vein.
 
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