ttglasscock
Contributor
Can I code 36005, 36005 & 75822 with 36558, 77001?
I'm thinking no according to the CCI edits but I'm not sure.
Indication/Pre-op Dx: End Stage Renal Disease with need for a more permanent access
Anesthesia & Drugs: Lido & epi 14ml SQ, Versed 0.5mg IV, Fentanyl 25mcg IV, contrast 36ml IV, Ancef 1gm IV, Radiation 17.21
Procedures:
Placement of tunneled dialysis catheter right Internal Jugular Vein
Bilateral injection procedure for venography bilateral upper extremities
Fluoroscopy for central line placement
Ultrasound evaluation of veins for vascular access and needle guidance
Procedure in Detail: We evaluated the shoulder and neck with ultrasound and documented electronically the patency of the jugular vein. We then started an IV in both wrists. We then performed bilateral venography of both upper extremities. We noted that the Cephalic Vein was not available in either arm for use in creating a fistula. The Basilic Vein was available in both arms. However, patient had bilateral Innominate Vein stenosis. We noted a right-sided Subclavian temporary type dialysis catheter. We also noted sternal wires in place. We then placed the patient in the procedure room and prepped and draped the right shoulder and neck in a sterile fashion. After a ?time out? we infiltrated with local anesthesia over the right neck and shoulder. We then used sterilely draped ultrasound probe to guide the needle into the Jugular Vein. Once we had a ?flash back? of venous blood, we advanced a guide wire through the needle. We then confirmed venous placement with fluoroscopy. We then made a small incision in the neck around the wire, and a small incision in the right infra-clavicular area. We tunneled a 19 cm catheter from the shoulder incision to the neck incision. We then dilated the Jugular vein over a wire. We then tunneled the catheter from the infra-clavicular area into the neck incision and inserted it through the tear-away sheath. We then positioned the catheter tip just inside the Right Atrium in the supine position. We aspirated the catheter ports to make sure that there was no obstruction to flow. We then flushed the catheters clear and filled them with heparin. We anchored the catheter with sutures and closed the neck incision. An appropriate dressing was applied. We then removed the old temporary type dialysis catheter from the Subclavian Vein.
Complications: none EBL: 15ml Specimen: existing temp cath
Findings/Post-op Dx:
Successful tunneled dialysis catheter placement right Internal Jugular Vein
The Basilic Vein is available in both arms for use in creating a fistula
There is significant bilateral Innominate Vein stenosis
Recommendations:
The new tunneled catheter may be used immediately
The patient should be considered for a HERO graft
I'm thinking no according to the CCI edits but I'm not sure.
Indication/Pre-op Dx: End Stage Renal Disease with need for a more permanent access
Anesthesia & Drugs: Lido & epi 14ml SQ, Versed 0.5mg IV, Fentanyl 25mcg IV, contrast 36ml IV, Ancef 1gm IV, Radiation 17.21
Procedures:
Placement of tunneled dialysis catheter right Internal Jugular Vein
Bilateral injection procedure for venography bilateral upper extremities
Fluoroscopy for central line placement
Ultrasound evaluation of veins for vascular access and needle guidance
Procedure in Detail: We evaluated the shoulder and neck with ultrasound and documented electronically the patency of the jugular vein. We then started an IV in both wrists. We then performed bilateral venography of both upper extremities. We noted that the Cephalic Vein was not available in either arm for use in creating a fistula. The Basilic Vein was available in both arms. However, patient had bilateral Innominate Vein stenosis. We noted a right-sided Subclavian temporary type dialysis catheter. We also noted sternal wires in place. We then placed the patient in the procedure room and prepped and draped the right shoulder and neck in a sterile fashion. After a ?time out? we infiltrated with local anesthesia over the right neck and shoulder. We then used sterilely draped ultrasound probe to guide the needle into the Jugular Vein. Once we had a ?flash back? of venous blood, we advanced a guide wire through the needle. We then confirmed venous placement with fluoroscopy. We then made a small incision in the neck around the wire, and a small incision in the right infra-clavicular area. We tunneled a 19 cm catheter from the shoulder incision to the neck incision. We then dilated the Jugular vein over a wire. We then tunneled the catheter from the infra-clavicular area into the neck incision and inserted it through the tear-away sheath. We then positioned the catheter tip just inside the Right Atrium in the supine position. We aspirated the catheter ports to make sure that there was no obstruction to flow. We then flushed the catheters clear and filled them with heparin. We anchored the catheter with sutures and closed the neck incision. An appropriate dressing was applied. We then removed the old temporary type dialysis catheter from the Subclavian Vein.
Complications: none EBL: 15ml Specimen: existing temp cath
Findings/Post-op Dx:
Successful tunneled dialysis catheter placement right Internal Jugular Vein
The Basilic Vein is available in both arms for use in creating a fistula
There is significant bilateral Innominate Vein stenosis
Recommendations:
The new tunneled catheter may be used immediately
The patient should be considered for a HERO graft