Shirleybala
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Hi,
I am having problem in coding this report thro a same point of access 2 guidewires are inserted and did a kissing ballon angioplasty in both baraciocephalic vein and kept 2 stents if we have to code 2 cath codes
Please help me to code this.
The patient's left arm was prepped and draped in the usual sterile
manner and locally anesthetized with lidocaine. Preliminary
ultrasound evaluation was done in the arm, demonstrating patent
left basilic vein, which was documented. Under real time
ultrasound guidance the left basilic vein was accessed with a
micropuncture set, image recorded. The access site was dilated
and 7 French vascular sheath was placed. Contrast was injected
and digital subtraction angiography was performed.
Findings:
There is high grade stenosis/ virtual occlusion of essentially the
entire length of the left brachiocephalic vein and a short segment
of the superior vena cava, just below the confluence of
brachiocephalic veins. Selective injection was performed to the
right brachiocephalic vein, confirming patency.
The left groin was then prepped and draped in the usual sterile
manner and locally anesthetized with lidocaine. The left common
femoral vein was accessed with a micropuncture set, exchange made
for a second seven French vascular sheath. A Berenstein catheter
and angled glide wire was then successfully advanced into the
super vena cava, across the high grade stenosis into the right
brachiocephalic vein. An exchange was made for a Rosen guide
wire. A second Rosen guidewire was advanced from the left groin
across the stenosis, right atrium and into the inferior vena cava.
After administration of 3000U IV heparin, Kissing balloon
angioplasty was performed of the superior vena cava extending into
both brachiocephalic veins, using 8mm diameter x 8cm long
balloons. Angiography performed after balloon dilatation
demonstrates no improvement.
Subsequently 2 stents were deployed; a 14 mm x 6 cm extending
from the SVC to the right brachiocephalic vein and a 14 mm x 8 cm
long luminex stent extending from the SVC into the left
brachiocephalic vein. The stents were post dilated to 10 mm again
with kissing balloons. Completion angiography was performed
demonstrating patency of the stents. However there still was poor
flow since the left brachiocephalic vein had not been stented
peripherally enough.
The port catheter tip again had to be repositioned, the catheter
tip was successfully pushed into the left axillary vein with a
Fogarty balloon. A second luminex stent was then placed, 12 mm x
4 cm extending further into the left brachiocephalic vein, just to
the IJ vein. This was post-dilated with a 10 mm balloon. The
port catheter tip in the left axillary vein was then snared from
the groin, and pulled back into the super vena cava. Completion
angiography was performed demonstrating improved flow, and patency
of all 3 stents with contiguous flow of contrast from the left
axillary vein into the right atrium.
At the end of the procedure both vascular sheaths were removed and
hemostasis achieved with manual compression. The patient
tolerated the procedure well, left the department in stable
condition.
Thanks,
Shirley
I am having problem in coding this report thro a same point of access 2 guidewires are inserted and did a kissing ballon angioplasty in both baraciocephalic vein and kept 2 stents if we have to code 2 cath codes
Please help me to code this.
The patient's left arm was prepped and draped in the usual sterile
manner and locally anesthetized with lidocaine. Preliminary
ultrasound evaluation was done in the arm, demonstrating patent
left basilic vein, which was documented. Under real time
ultrasound guidance the left basilic vein was accessed with a
micropuncture set, image recorded. The access site was dilated
and 7 French vascular sheath was placed. Contrast was injected
and digital subtraction angiography was performed.
Findings:
There is high grade stenosis/ virtual occlusion of essentially the
entire length of the left brachiocephalic vein and a short segment
of the superior vena cava, just below the confluence of
brachiocephalic veins. Selective injection was performed to the
right brachiocephalic vein, confirming patency.
The left groin was then prepped and draped in the usual sterile
manner and locally anesthetized with lidocaine. The left common
femoral vein was accessed with a micropuncture set, exchange made
for a second seven French vascular sheath. A Berenstein catheter
and angled glide wire was then successfully advanced into the
super vena cava, across the high grade stenosis into the right
brachiocephalic vein. An exchange was made for a Rosen guide
wire. A second Rosen guidewire was advanced from the left groin
across the stenosis, right atrium and into the inferior vena cava.
After administration of 3000U IV heparin, Kissing balloon
angioplasty was performed of the superior vena cava extending into
both brachiocephalic veins, using 8mm diameter x 8cm long
balloons. Angiography performed after balloon dilatation
demonstrates no improvement.
Subsequently 2 stents were deployed; a 14 mm x 6 cm extending
from the SVC to the right brachiocephalic vein and a 14 mm x 8 cm
long luminex stent extending from the SVC into the left
brachiocephalic vein. The stents were post dilated to 10 mm again
with kissing balloons. Completion angiography was performed
demonstrating patency of the stents. However there still was poor
flow since the left brachiocephalic vein had not been stented
peripherally enough.
The port catheter tip again had to be repositioned, the catheter
tip was successfully pushed into the left axillary vein with a
Fogarty balloon. A second luminex stent was then placed, 12 mm x
4 cm extending further into the left brachiocephalic vein, just to
the IJ vein. This was post-dilated with a 10 mm balloon. The
port catheter tip in the left axillary vein was then snared from
the groin, and pulled back into the super vena cava. Completion
angiography was performed demonstrating improved flow, and patency
of all 3 stents with contiguous flow of contrast from the left
axillary vein into the right atrium.
At the end of the procedure both vascular sheaths were removed and
hemostasis achieved with manual compression. The patient
tolerated the procedure well, left the department in stable
condition.
Thanks,
Shirley
Last edited: