chembree
Guru
I emailed our doctor for clarification on the below report to help us distinguish if the CVA w/port was replaced or just repositioned.
His response to me was…
“I repositioned, but not just the catheter, the port itself was extracted... the pocket opened, port extracted, fat dissected (? lipectomy charge), new pocket beneath the original created, pockets washed out with ancef, the port replaced into the new pocket, secured down with new sutures and incision closed. Technically a reposition, but replaced into a new pocket. For cost reasons, I elected to not put in a new one, due to lack of any evidence of infection and the short time it was in the body.
Time wise, more lengthy than a first time placement of a port.”
My question is what can we charge for with this patient? I am looking at CPT 36597, 76000 and CPT 99144. Our doctor has asked about the lipectomy/ CPT 15839. This is not a service we normally charge for but when I ran it through the CCI edits it does not bundle. Can anyone offer any feedback?
INDICATION: Chest port chest port was flipped in subcutaneous tissues.
Chest Port was originally placed 3/1/2012.
TECHNIQUE: The risks, benefits and procedural details were discussed with the patient prior to proceeding. The patient was brought into the interventional suite and the left upper chest was prepped and draped in usual sterile fashion. Strict sterile technique was followed. Hat, mask, chlorhexidine hand washing, and full draping were all utilized.
IV Versed and fentanyl were utilized for adequate and effective conscious sedation throughout the procedure for total of 30 minutes.. Patient received 2 grams of Ancef given intravenously just before procedure.
Fluoroscopic time: 0.0 minutes. One fluoroscopic exposure equaling 1.8 uGym2.
1% lidocaine without epinephrine was used as local anesthetic and the subcutaneous tissues of the left upper chest were anesthetized successfully. A 15 blade was utilized to make a transverse incision 3 to 4 cm in length at the site of existing scar.. The subcutaneous pocket was dissected using blunt dissection and with electrocautery. The existing chest port was then removed removing existing anchor sutures from its pocket. This allowed deeper pocket creation within the subcutaneous fat with subcutaneous fat being removed to allow anchoring to the deeper fascia. The pocket was cleansed with 1 gram of Ancef and 250 cc of saline prior to replacement of port. The port was secured with 3 anchoring sutures using 3-0 Ethilon sutures into the deep fascial layer. The port 's stability was tested. The port was loaded with 100 units heparin. The pocket was then closed with 3-0 Vicryl fascial layer and 4-0 Vicryl subcuticular layer closure. Steri-Strips were placed. Sterile dressings were applied. The patient tolerated the procedure well and was transferred to recovery unit in stable condition.
The procedure was performed using hat, mask, sterile gown and large sterile sheet. A chlorhexidine hand sanitation was also utilized along with full large drape.
IMPRESSION: Successful revision of chest port as described.
Thank you for referring your patient to Interventional Radiology for their procedure and allowing me to participate with you in their care.
His response to me was…
“I repositioned, but not just the catheter, the port itself was extracted... the pocket opened, port extracted, fat dissected (? lipectomy charge), new pocket beneath the original created, pockets washed out with ancef, the port replaced into the new pocket, secured down with new sutures and incision closed. Technically a reposition, but replaced into a new pocket. For cost reasons, I elected to not put in a new one, due to lack of any evidence of infection and the short time it was in the body.
Time wise, more lengthy than a first time placement of a port.”
My question is what can we charge for with this patient? I am looking at CPT 36597, 76000 and CPT 99144. Our doctor has asked about the lipectomy/ CPT 15839. This is not a service we normally charge for but when I ran it through the CCI edits it does not bundle. Can anyone offer any feedback?
INDICATION: Chest port chest port was flipped in subcutaneous tissues.
Chest Port was originally placed 3/1/2012.
TECHNIQUE: The risks, benefits and procedural details were discussed with the patient prior to proceeding. The patient was brought into the interventional suite and the left upper chest was prepped and draped in usual sterile fashion. Strict sterile technique was followed. Hat, mask, chlorhexidine hand washing, and full draping were all utilized.
IV Versed and fentanyl were utilized for adequate and effective conscious sedation throughout the procedure for total of 30 minutes.. Patient received 2 grams of Ancef given intravenously just before procedure.
Fluoroscopic time: 0.0 minutes. One fluoroscopic exposure equaling 1.8 uGym2.
1% lidocaine without epinephrine was used as local anesthetic and the subcutaneous tissues of the left upper chest were anesthetized successfully. A 15 blade was utilized to make a transverse incision 3 to 4 cm in length at the site of existing scar.. The subcutaneous pocket was dissected using blunt dissection and with electrocautery. The existing chest port was then removed removing existing anchor sutures from its pocket. This allowed deeper pocket creation within the subcutaneous fat with subcutaneous fat being removed to allow anchoring to the deeper fascia. The pocket was cleansed with 1 gram of Ancef and 250 cc of saline prior to replacement of port. The port was secured with 3 anchoring sutures using 3-0 Ethilon sutures into the deep fascial layer. The port 's stability was tested. The port was loaded with 100 units heparin. The pocket was then closed with 3-0 Vicryl fascial layer and 4-0 Vicryl subcuticular layer closure. Steri-Strips were placed. Sterile dressings were applied. The patient tolerated the procedure well and was transferred to recovery unit in stable condition.
The procedure was performed using hat, mask, sterile gown and large sterile sheet. A chlorhexidine hand sanitation was also utilized along with full large drape.
IMPRESSION: Successful revision of chest port as described.
Thank you for referring your patient to Interventional Radiology for their procedure and allowing me to participate with you in their care.
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