suela923@aol.com
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I coded this as 37192, 35476, 75978 because the doctor's intention was to do a retrieval but he was actually only able to accomplish a reposition. I am being told it should be 37193-74. Any thoughts? Thanks, Sue
Ultrasound and fluoroscopic guided venacavogram and IVC filter retrieval attempt; IVC filter repositioning.
History: Pulmonary embolism following orthopedic surgery. For IVC filter retrieval as there is no longer a contraindication to anticoagulation.
Technique: Time out was performed. Skin over right neck prepped and draped sterilely. 2% lidocaine used as a local anesthetic. Moderate sedation also administered. Ultrasound used to determine potential access sites and for real-time guidance into the right internal jugular vein. Images recorded and made part of the patient's permanent medical record. An 18-gauge needle inserted into the right internal jugular vein, wire was advanced down the IVC into the infrarenal IVC. Sheath was advanced over the wire and a venacavogram was performed. Under fluoroscopic guidance, the apex of the filter could not be snared with a loop snare so a 5-French Motarjeme catheter was advanced below the filter and a 0.014 inch guidewire was placed above the filter through the catheter and snared through the sheath. With control of the filter, the filter was repositioned but became deformed. An 8 and 14 mm balloon along with wires and catheters were used in an attempt to reposition the filter caudally. This was not successful. Decision was therefore made to reposition the filter into the right internal jugular vein and to remove the sheath. This was performed under fluoroscopic guidance. Sheath and wires were removed. Hemostasis was achieved using manual compression.
Findings: The right internal jugular vein is widely patent and normally compressible. Needle is seen coursing into the vein. Venacavogram shows the apex of the filter at L2-L3 directed towards the patient's left and embedded in the IVC filter wall. The apex of the filter could not be snared. With control of the filter as described above, the filter was repositioned more cephalad but became deformed. The apex again could not be snared. Filter could not be repositioned more caudally as described above. The filter was then deployed in the right internal jugular vein and the sheaths and wires were removed. The atrial pacemaker lead was displaced into the right internal jugular vein as well. Final AP view of the chest was obtained.
The procedure, course of events, and outcome were discussed in detail personally with the patient as well as his daughter, Allison. All of their questions were answered. In addition, I spoke over the telephone with Dr. Bernabei from cardiology. Their office is going to contact the patient for followup early next week. In addition, the patient will followup with us next week.
Result Impression
Unsuccessful IVC filter retrieval.
Repositioning of the IVC filter into the right internal jugular vein with inadvertent repositioning of the atrial pacemaker lead into the right internal jugular vein as well
Ultrasound and fluoroscopic guided venacavogram and IVC filter retrieval attempt; IVC filter repositioning.
History: Pulmonary embolism following orthopedic surgery. For IVC filter retrieval as there is no longer a contraindication to anticoagulation.
Technique: Time out was performed. Skin over right neck prepped and draped sterilely. 2% lidocaine used as a local anesthetic. Moderate sedation also administered. Ultrasound used to determine potential access sites and for real-time guidance into the right internal jugular vein. Images recorded and made part of the patient's permanent medical record. An 18-gauge needle inserted into the right internal jugular vein, wire was advanced down the IVC into the infrarenal IVC. Sheath was advanced over the wire and a venacavogram was performed. Under fluoroscopic guidance, the apex of the filter could not be snared with a loop snare so a 5-French Motarjeme catheter was advanced below the filter and a 0.014 inch guidewire was placed above the filter through the catheter and snared through the sheath. With control of the filter, the filter was repositioned but became deformed. An 8 and 14 mm balloon along with wires and catheters were used in an attempt to reposition the filter caudally. This was not successful. Decision was therefore made to reposition the filter into the right internal jugular vein and to remove the sheath. This was performed under fluoroscopic guidance. Sheath and wires were removed. Hemostasis was achieved using manual compression.
Findings: The right internal jugular vein is widely patent and normally compressible. Needle is seen coursing into the vein. Venacavogram shows the apex of the filter at L2-L3 directed towards the patient's left and embedded in the IVC filter wall. The apex of the filter could not be snared. With control of the filter as described above, the filter was repositioned more cephalad but became deformed. The apex again could not be snared. Filter could not be repositioned more caudally as described above. The filter was then deployed in the right internal jugular vein and the sheaths and wires were removed. The atrial pacemaker lead was displaced into the right internal jugular vein as well. Final AP view of the chest was obtained.
The procedure, course of events, and outcome were discussed in detail personally with the patient as well as his daughter, Allison. All of their questions were answered. In addition, I spoke over the telephone with Dr. Bernabei from cardiology. Their office is going to contact the patient for followup early next week. In addition, the patient will followup with us next week.
Result Impression
Unsuccessful IVC filter retrieval.
Repositioning of the IVC filter into the right internal jugular vein with inadvertent repositioning of the atrial pacemaker lead into the right internal jugular vein as well