dvelasquez6
New
Hello, Can someone please help coding the following:
So far I have
36902
36908
36012
37248
Thanks in advance
FINDINGS & PROCEDURE: After informed consent and under sterile conditions the right forearm fistula was accessed in the venous direction and a 5 French sheath was established. Using real time ultrasound guidance, access was obtained to the right femoral vein and a 7 French sheath was established. A fistulagram was performed revealing a patent forearm cephalic vein stenosis. A 70% axillary vein stenosis was noted. Centrally a 90% SCV and 100% complete central vein occlusion is noted of the right BCV. In a retrograde manner an inflow arteriogram was performed revealing a modest inflow stenosis. A wire directed selective catheter was required to traverse the outflow lesion. An 8mm PTA was performed of the stenosis of the axillary vein. An 8mm PTA was performed of the subclavian vein stenosis. A Glidewire and selective catheter was advanced through the CFV, EIV, CIV, IVC, RA and SVC to the right BCV. A dedicated SVCgram was performed which confirmed a total occlusion and collateral veins maintain patency. Thrombus was manually aspirated and mechanically cleared from the right BCV. Several attempts were made to traverse the complete occlusion with ultimate success using a stiff Terumo glid and a Glidecatheter. The central vein occlusion was recanalized with serial PTA of 4mm, 8mm then 10mm PTA. A 14x40mm stent was ultimately deployed and then post-dilated to 10mm to restore in-line flow the fistula circuit. A good thrill was noted clinically and follow-up fistulagram and venogram demonstrated wide patency. Hemostasis was obtained. IMPRESSION/PLAN: Right forearm fistulagram, venogram and arteriogram with successful angioplasty, 14x40mm stent placement and central vein recanalization with venous thrombectomy.
So far I have
36902
36908
36012
37248
Thanks in advance
FINDINGS & PROCEDURE: After informed consent and under sterile conditions the right forearm fistula was accessed in the venous direction and a 5 French sheath was established. Using real time ultrasound guidance, access was obtained to the right femoral vein and a 7 French sheath was established. A fistulagram was performed revealing a patent forearm cephalic vein stenosis. A 70% axillary vein stenosis was noted. Centrally a 90% SCV and 100% complete central vein occlusion is noted of the right BCV. In a retrograde manner an inflow arteriogram was performed revealing a modest inflow stenosis. A wire directed selective catheter was required to traverse the outflow lesion. An 8mm PTA was performed of the stenosis of the axillary vein. An 8mm PTA was performed of the subclavian vein stenosis. A Glidewire and selective catheter was advanced through the CFV, EIV, CIV, IVC, RA and SVC to the right BCV. A dedicated SVCgram was performed which confirmed a total occlusion and collateral veins maintain patency. Thrombus was manually aspirated and mechanically cleared from the right BCV. Several attempts were made to traverse the complete occlusion with ultimate success using a stiff Terumo glid and a Glidecatheter. The central vein occlusion was recanalized with serial PTA of 4mm, 8mm then 10mm PTA. A 14x40mm stent was ultimately deployed and then post-dilated to 10mm to restore in-line flow the fistula circuit. A good thrill was noted clinically and follow-up fistulagram and venogram demonstrated wide patency. Hemostasis was obtained. IMPRESSION/PLAN: Right forearm fistulagram, venogram and arteriogram with successful angioplasty, 14x40mm stent placement and central vein recanalization with venous thrombectomy.