Wiki ECMO AND CVL

[codinggirl]

What documentation is necessary to code a CVL with an ECMO? I do not think my info supports medical necessity for CVL nor describes a CVL?

My documentation indicates under US/fluoro a 9F cordis sheath was placed in the left subclavian and previous swan removed then using a JR4 catheter a j-wire is placed in IVC. Next wire is placed in IVC and dilatation is performed.

 

[antoniamay]

You noted that the Swan-Ganz catheter was removed and a JR4 catheter with j-wire was placed into the IVC, followed by dilatation. This sequence suggests preparation for cannulation—possibly for ECMO circuit access—but it’s difficult to confirm based on the current note. I ask the provider to clarify if the sheath was placed for postoperative use, such as rapid infusion or monitoring, please specify that in the documentation. Typically, if the sheath is not removed at the end of the procedure, which you may want to check there to see if they mention leaving it for a specific purpose, that supports its use beyond intraoperative access. However, without a clear statement of intent, we cannot confidently assign a CVL code or append modifier 59 in my opinion.