cheyenne378
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IVC FILTER PLACEMENT - DR REPORT BELOW - MY COMMENTS IN PARENTHESIS - I AM ON THE FENCE WHETHER OR NOT 37191 IS THE ONLY CODE NECESSARY. ANY HELP WOULD BE APPRECIATED!!!!! ONE CONFUSED CPC, KATHY
*Catheterization inferior vena cava 36010,
*Inferior venacavogram 75825, (venography, caval, inferior, with
serialography, radiological supervision and interpretation.)
*IVC filter placement 37620 (deleted code), 75940 (deleted code)
Ultrasound - guided vascular Access 76937 (see 37191 this is included)
HISTORY - Pulmonary embolism. Lung malignancy.
CONSENT: Informed consent was obtained prior to procedure. Discussed risks included but were not limited to bleeding, infection, allergy, nerve injury, filter migration, or lower extremity swelling from venous stasis.
FLUOROSCOPY TIME: 1.7 minutes.
TECHNIQUE:
The right neck was prepped and draped in the usual sterile fashion. Local anesthesia 2% lidocaine was administered to the skin and soft tissues overlying the right internal jugular vein. The right internal jugular vein was then punctured using Seldinger technique with a micropuncture needle. A 0.018 guidewire was then advanced into the jugular vein. A transitional dilator was advanced over this wire into the vein. A standard 0.035 inch guidewire was then advanced into the inferior vena cava. The sheath for the filter was advanced and positioned in the inferior vena cava. Contrast was injected with digital subtraction imaging to perform inferior vena cavogram. A Trapease IVC filter was then deployed in the infrarenal IVC so that the superior aspect of the filter was below the level of the remal veins. Spot radiograph was obtained to document positioning of the filter. Pathient ws then sat up and the sheath was removed with manual compression applied at the jugular puncture site until complete hemostasis was achieved. Patient tolerated the procedure well and there are no apparent complications.
FINDINGS:
To minimize risk of bleeding in this particular patient, a jugular approach was used for filter placement.
Inferior vena cavogram shows patency of the inferior vena cava with inflow defects from single renal veins bilaterally. There was subsequent technically successful placement of an IVC filter in the infrarenal IVC as detailed above.
IMPRESSION:
Successful infrarenal IVC filter placement.
This case was done with Dr K. (one of our radiologists) present.
End of study.
***Please look at code on page 219 - CPT - this might work for the entire
study:
37191 - Insertion of intravascular vena cava filter, endovascular
approach including vascular access, vessel selection, and radiological
supervision and interpretation, intraprocedural roadmappying and imaging
guidance (Ultrasound and fluoroscopy), when performed.
*Catheterization inferior vena cava 36010,
*Inferior venacavogram 75825, (venography, caval, inferior, with
serialography, radiological supervision and interpretation.)
*IVC filter placement 37620 (deleted code), 75940 (deleted code)
Ultrasound - guided vascular Access 76937 (see 37191 this is included)
HISTORY - Pulmonary embolism. Lung malignancy.
CONSENT: Informed consent was obtained prior to procedure. Discussed risks included but were not limited to bleeding, infection, allergy, nerve injury, filter migration, or lower extremity swelling from venous stasis.
FLUOROSCOPY TIME: 1.7 minutes.
TECHNIQUE:
The right neck was prepped and draped in the usual sterile fashion. Local anesthesia 2% lidocaine was administered to the skin and soft tissues overlying the right internal jugular vein. The right internal jugular vein was then punctured using Seldinger technique with a micropuncture needle. A 0.018 guidewire was then advanced into the jugular vein. A transitional dilator was advanced over this wire into the vein. A standard 0.035 inch guidewire was then advanced into the inferior vena cava. The sheath for the filter was advanced and positioned in the inferior vena cava. Contrast was injected with digital subtraction imaging to perform inferior vena cavogram. A Trapease IVC filter was then deployed in the infrarenal IVC so that the superior aspect of the filter was below the level of the remal veins. Spot radiograph was obtained to document positioning of the filter. Pathient ws then sat up and the sheath was removed with manual compression applied at the jugular puncture site until complete hemostasis was achieved. Patient tolerated the procedure well and there are no apparent complications.
FINDINGS:
To minimize risk of bleeding in this particular patient, a jugular approach was used for filter placement.
Inferior vena cavogram shows patency of the inferior vena cava with inflow defects from single renal veins bilaterally. There was subsequent technically successful placement of an IVC filter in the infrarenal IVC as detailed above.
IMPRESSION:
Successful infrarenal IVC filter placement.
This case was done with Dr K. (one of our radiologists) present.
End of study.
***Please look at code on page 219 - CPT - this might work for the entire
study:
37191 - Insertion of intravascular vena cava filter, endovascular
approach including vascular access, vessel selection, and radiological
supervision and interpretation, intraprocedural roadmappying and imaging
guidance (Ultrasound and fluoroscopy), when performed.