Sephardic
Networker
I've got a procedure one of my radiology doctors did and I can't make heads or tails of it. I'm not sure if there's a code that covers what he appears to have done. I was just wondering if anyone could give me some ideas. This patient has a feeding tube (either in his mouth or nose) extending into his duodenum. Thanks!
History: Failure to thrive.
Technique and findings: The procedure was discussed with the
patient's parents. They were present for the procedure. Under
fluoroscopy, the patient's existing small bore feeding tube was then
pulled back so the tip was in the stomach. Initially, there was
difficulty injecting the barium through the feeding tube, however was
noted the tube was kinked upon itself as multiple loops had to be
pulled back. Thin barium was instilled through the feeding tube into
the stomach under under intermittent fluoroscopic visualization.
Contrast pooled in the fundus and the patient was placed in a right
lateral decubitus position. Once contrast extended to the antrum, it
rapidly filled the duodenum. Gastroesophageal reflux was identified
to the mid thoracic esophagus. The tube was flushed with a small
amount of water. Then, the stylet for a new feeding tube was inserted
into the existing feeding tube and it was repositioned with its tip
at the junction of the second and third duodenum. It was affixed to
the patient's skin. He tolerated procedure well. No immediate
complications. Additionally, limited fluoroscopy was performed to
identify the left-sided PICC line, the tip overlies left
brachiocephalic vein just left of midline.
Impression:
1. When the thin barium was placed into the antrum, it flowed freely
and quickly into the duodenum without evidence of obstruction.
Gastroesophageal reflux was noted during this study as described.
2. It was noted that a left-sided PICC line extends to the left
brachiocephalic vein as described.
History: Failure to thrive.
Technique and findings: The procedure was discussed with the
patient's parents. They were present for the procedure. Under
fluoroscopy, the patient's existing small bore feeding tube was then
pulled back so the tip was in the stomach. Initially, there was
difficulty injecting the barium through the feeding tube, however was
noted the tube was kinked upon itself as multiple loops had to be
pulled back. Thin barium was instilled through the feeding tube into
the stomach under under intermittent fluoroscopic visualization.
Contrast pooled in the fundus and the patient was placed in a right
lateral decubitus position. Once contrast extended to the antrum, it
rapidly filled the duodenum. Gastroesophageal reflux was identified
to the mid thoracic esophagus. The tube was flushed with a small
amount of water. Then, the stylet for a new feeding tube was inserted
into the existing feeding tube and it was repositioned with its tip
at the junction of the second and third duodenum. It was affixed to
the patient's skin. He tolerated procedure well. No immediate
complications. Additionally, limited fluoroscopy was performed to
identify the left-sided PICC line, the tip overlies left
brachiocephalic vein just left of midline.
Impression:
1. When the thin barium was placed into the antrum, it flowed freely
and quickly into the duodenum without evidence of obstruction.
Gastroesophageal reflux was noted during this study as described.
2. It was noted that a left-sided PICC line extends to the left
brachiocephalic vein as described.