Wiki Lower Extremity Cath Placement & IVUS

KQuinones0111

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Hi, I want to make sure that I am coding for Lower Extremity Cath Placement and IVUS correctly. If someone could please look over these and let me know if I am coding something incorrectly.

Patient was prepped and draped in sterile fashion after informed consent was obtained. Under my direct supervision, moderate sedation was administered with the continuous monitoring of hemodynamic parameters by RN. Total sedation time was 30 minutes using Fentanyl and Versed. Using u/s guidance, right common femoral vein was visualized. A micropuncture kit was used to access the right common femoral vein under u/s guidance. Image of the vein was recorded and saved. A 8 Farench sheath was inserted into the right common femoral vein. Selective venogram was performed to visualize the anatomy of the IVC, the common iliac veins and the common femoral veins. After venogram, the Volcano intravascular u/s catheter was inserted antegrade from right common femoral vein. The IVUS catheter was advanced into the IVC with measurements obtained and recorded during catheter retraction into the right common iliac vein, followed by the external iliac vein, and concluding with the common femoral vein. IVUS catheter was removed from the body. After obtaining measurements, the sheath in the right groin was exchanged for a 10 F sheath. An 18 x 10 mm WallStent was advanced and deployed in the right common iliac vein down to the right external iliac vein. Stent was post dilated with XXL 18mm x 4 cm balloon. IVUS catheter re-advanced through right groin access and up to IVC, slow pull back with measurements obtained and recorded as post interventional. Sheath on the right side pulled and manual pressure held with good hemostasis. Patient transferred to recovery in stable condition.

I coded:
99152
99153
76937
75820 - 59, RT
37252
37253 x 2
37238
36012
 
Patient was prepped and draped in sterile fashion after informed consent was obtained. Under my direct supervision, moderate sedation was administered with the continuous monitoring of hemodynamic parameters by RN. Total sedation time was 30 minutes using Fentanyl and Versed (99152 and 99153 here, although I believe best practice is that this statement should include the phrase "total face to face" sedation time was 30 minutes). Using u/s guidance, right common femoral vein was visualized. A micropuncture kit was used to access the right common femoral vein under u/s guidance. Image of the vein was recorded and saved. (I would suggest provider include a statement of selected vessel patency. So I would not award 76937 here.) A 8 Farench sheath was inserted into the right common femoral vein. Selective venogram was performed to visualize the anatomy of the IVC, the common iliac veins and the common femoral veins. (75820-59 maybe, see comments below)After venogram, the Volcano intravascular u/s catheter was inserted antegrade from right common femoral vein. The IVUS catheter was advanced into the IVC with measurements obtained and recorded during catheter retraction into the right common iliac vein, followed by the external iliac vein, and concluding with the common femoral vein (I would award 36010 and 37252, 37253x2 based off of this sentence). IVUS catheter was removed from the body. After obtaining measurements, the sheath in the right groin was exchanged for a 10 F sheath. An 18 x 10 mm WallStent was advanced and deployed in the right common iliac vein down to the right external iliac vein. Stent was post dilated with XXL 18mm x 4 cm balloon. (37238 here) IVUS catheter re-advanced through right groin access and up to IVC, slow pull back with measurements obtained and recorded as post interventional. Sheath on the right side pulled and manual pressure held with good hemostasis. Patient transferred to recovery in stable condition.


Final Coding:
99152/99153 *suggest integration of phrase "face to face total sedation time"
36010 For IVC catheterization, the most distal placement achieved during this ipsilateral study
37252 IVUS, R comm iliac vein
37253x2 IVUS, R Ext Iliac and Common Femoral Veins
37238 Stent to Right Common Iliac, possibly extending into Right External Iliac

Comments/Thoughts:
* I would work with provider to apply the phrase "total face to face sedation time" into moderate sedation statement
* I would not award 76937 because the provider's US guidance statement does not provide a eval of selected vessel patency/non patency
* I would only award the 75820-59 if I have established there was no prior study performed on this patient of this area/for this current problem, and only if your report here provides findings/interp of the venogram.
* Your study appears to be ipsilateral in nature, a R common femoral vein approach, and the documentation only provides evidence of the most distal placement being the IVC. so I feel evidence only supports a 36010

Thank you, hope this is helpful.
Jayna
 
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