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Haven't coded one of these in a while, and i'm having trouble remembering re the venogram and the infusion catheter insertion...first day venous......what code(s)….do I code the venogram and also cath placement via same vein? what codes for the venogram and catheter insertion?

  • limited ultrasound of the right arm was performed to choose a
    site for insertion of the infusion catheter. The skin overlying
    the site was marked and subsequently prepped and draped in
    sterile fashion. Local anesthesia using 0.2% Ropivacaine was
    injected at the insertion site. Using real-time ultrasound
    guidance, the right brachial vein was punctured with a 21-gauge
    needle. Once venous blood was obtained, a 0.018 inch Cope wire
    was inserted into the vein. The needle was exchanged for a 5
    French micropuncture sheath and a venogram was performed.

    Next, a 0.035 inch Newton wire was inserted into the brachial
    vein and the micropuncture sheath was exchanged for a 5 French
    vascular sheath. After performing a roadmap venogram, a 5 French
    angled glide catheter was used coaxially with a 0.035" Glidewire
    to cross the area of right brachial/axillary and subclavian
    thrombosis, and position the tip of the Glidewire in the inferior
    vena cava via the in line brachial vein. The Glidewire was
    exchanged for a 0.035" x 180 cm Amplatz wire. The glide catheter
    was removed over the wire and exchanged for the 5 French x 90 cm
    infusion catheter with a 20 cm segment of side holes for tPA
    infusion. Once the infusion catheter was inserted to the desired
    position, the Amplatz wire was removed and the occlusion wire was
    inserted. The vascular sheath was secured to the skin with 3-0
    Prolene suture. The infusion catheter and access sheath were
    labeled "tPA" and "saline," respectively. The infusion catheter
    and side arm of the access sheaths were secured to the skin with
    multiple Grip-LOK securing devices. The sheath insertion site was
    dressed with split gauze and a Tegaderm dressing. The tPA
    infusion was connected and started at 1 mg/hour.