smwaters
Contributor
I'm at a Children's Hospital and we often treat venous malformations all over the body. Sometimes they are categorized as bleb nevus sydrome as in the case below. I don't think 36468-36471 are appropriate since those are for spider veins. It has been recommended by an ex IR physician who now works for a coding company to use 61626 or 37205.
Excerpt from report: Sonographic guidance was used to cannulate multiple venous malformations using 20-gauge catheters and 21-gauge echo-tipped needles. The larger sites were evaluated with contrast venography, digital subtraction technique, which were recorded. Smaller lesions were injected directly using sonographic guidance to confirm intralesional injection. After treating these sites that were prepped, the left forearm and hand was sterilely prepared and draped in treated. The patient was then rolled onto his left side and the mid posterior chest wall was sterilely prepared. One superficial lesion near the spinous process of T2 was injected.
Right elbow. This was evaluated but no venous malformation was identified and no injection was made.
Right middle finger. 0.75 units of bleomycin was injected in two sites under the nailbed.
Right ring finger. Syrup 0.5-ML bleomycin, one unit/ML, was injected into the finger tip in nail bed.
Right anterior abdominal wall. Three amount of 3% STS foam followed by 3amount [3 units] bleomycin were injected. The site was compressed.
Left lower anterior abdominal wall. A small sessile lesion was injected with 2.5-ML of half-strength bleomycin
Left foot. Third toe, one unit of bleomycin, second toe, syrup 0.5-ML bleomycin, superficial lesion on the sole of the foot, one ML bleomycin.
Right foot. Venous malformation dorsal surface, 0.5-ML bleomycin. Right great toe deep lesion, 0.5-ML STS followed by bleomycin 0.5 units with compression.
Left dorsal forearm one ML of bleomycin
Left wrist, flexor surface one ML STS, second lesion on ML STS
Left ring finger distal one ML STS
Left middle finger, distal, one ML STS
Right index finger, distal, one ML STS
Proximal mid posterior thorax, 0.5-ML STS
Right lateral proximal thigh, 0.5-ML STS
Thoughts, ideas? Anything advice is greatly appreciated. I'm hoping someone out there deals with these and at the very least can tell me how they handle them.
Excerpt from report: Sonographic guidance was used to cannulate multiple venous malformations using 20-gauge catheters and 21-gauge echo-tipped needles. The larger sites were evaluated with contrast venography, digital subtraction technique, which were recorded. Smaller lesions were injected directly using sonographic guidance to confirm intralesional injection. After treating these sites that were prepped, the left forearm and hand was sterilely prepared and draped in treated. The patient was then rolled onto his left side and the mid posterior chest wall was sterilely prepared. One superficial lesion near the spinous process of T2 was injected.
Right elbow. This was evaluated but no venous malformation was identified and no injection was made.
Right middle finger. 0.75 units of bleomycin was injected in two sites under the nailbed.
Right ring finger. Syrup 0.5-ML bleomycin, one unit/ML, was injected into the finger tip in nail bed.
Right anterior abdominal wall. Three amount of 3% STS foam followed by 3amount [3 units] bleomycin were injected. The site was compressed.
Left lower anterior abdominal wall. A small sessile lesion was injected with 2.5-ML of half-strength bleomycin
Left foot. Third toe, one unit of bleomycin, second toe, syrup 0.5-ML bleomycin, superficial lesion on the sole of the foot, one ML bleomycin.
Right foot. Venous malformation dorsal surface, 0.5-ML bleomycin. Right great toe deep lesion, 0.5-ML STS followed by bleomycin 0.5 units with compression.
Left dorsal forearm one ML of bleomycin
Left wrist, flexor surface one ML STS, second lesion on ML STS
Left ring finger distal one ML STS
Left middle finger, distal, one ML STS
Right index finger, distal, one ML STS
Proximal mid posterior thorax, 0.5-ML STS
Right lateral proximal thigh, 0.5-ML STS
Thoughts, ideas? Anything advice is greatly appreciated. I'm hoping someone out there deals with these and at the very least can tell me how they handle them.