rejenia
Networker
First time coding this type of procedure and I have some code not sure they care correct.
PROCEDURE PERFORMED:
1. Ultrasound-guided placement of sheaths x2 into left common femoral vein.
Permanent images were saved.
2. Pulmonary arteriogram bilaterally with selective catheterization of right
and left main pulmonary arteries. 36014 75743:26
3. Selective catheterization of right inferior pulmonary artery segmental
branch. 36015
4. Selective catheterization of right superior pulmonary artery segmental
branch. 36015
5. Tissue plasminogen activator instillation into right superior pulmonary
artery as well as the right inferior and middle lobe pulmonary artery.
6. Selective catheterization of right middle lobe pulmonary artery.
7. Selective catheterization of left superior and inferior lobe pulmonary
arteries with tissue plasminogen activator instillation into left inferior
pulmonary artery.
8. Initiation of thrombolytic therapy with 12 cm EKOS catheter placed into
ight main pulmonary artery and right inferior pulmonary artery.
9. A 6 cm EKOS catheter placement into left main and inferior pulmonary artery.
10. Inferior vena cavogram.
11. Selective catheterization of right common femoral and external iliac
arteries from a left femoral vein approach. 36012 36012 36012 75820:26
IVC 36010 venogram 75825:26
PROCEDURE IN DETAIL:
After appropriate informed consent was obtained, patient was brought to the
angiographic suite. A time-out was performed. Patient was identified. He
was laid supine. Left groin was prepped and draped in the usual sterile
manner. Right groin was ultrasounded and had an extensive DVT consistent with iliofemoral DVT. Ultrasound-guided access was performed with a micropuncture needle and micropuncture sheaths x2 placed in the left common femoral vein. Permanent images were stored.
Two initial 6-French short sheaths were placed.
An initial pigtail catheter was placed into the inferior vena cava and an
inferior vena cavogram was taken. Inferior vena cavogram demonstrated a
atent left external iliac and common iliac veins with patent inferior vena
cava. The catheter was then used to select out the right common femoral vein and right external and common iliac veins. This showed thrombus within the right external iliac vein and common femoral vein consistent with the known iliofemoral DVT. Right internal iliac vein was patent with right to left
collaterals noted. There was no over thrombus or filling defect in the cava.
At this point, one of the 690 sheaths was exchanged out for a 670 Ansel
sheath. The Ansel sheath was placed into the inferior vena cava. A floppy
Glidewire was then used to gain access to the main pulmonary artery. Both
sheaths were then placed into the main pulmonary artery. A pigtail catheter
was placed into the right and left pulmonary arteries respectively and initial
pulmonary arteriograms were taken.
Initial pulmonary arteriogramsdemonstrated occlusive thrombus going into the right superior pulmonary artery, right middle pulmonary artery and right inferior pulmonary artery branches. The thrombus started out in the lobar branches and were occlusive of the segmental and subsegmental branches with diminished perfusion of the branches.
A decision was made to intervene and a Kumpe catheter was used to select out the right superior lobar and segmental branches, as well as the right inferior as well as middle lobar and segmental branches. TPA 2 mg was instilled into the junction of the right middle and inferior lobar pulmonary arteries and 2 mg of tPA was instilled to the right superior lobar pulmonary artery.
Once this was done, a 12 cm EKOS catheter was placed extending from the main right pulmonary artery into the inferior and middle lobe lobar branches. Next, selective catheterizations were performed of the left superior lingual and
inferior pulmonary arteries. This demonstrated significant thrombus burden in
the lingual and inferior branches. TPA 2 mg was instilled through the Kumpe
catheter. A 6 cm EKOS was then placed into the left pulmonary artery
extending into the middle and inferior branches. TPA was begun at 0.75 mg/h
through each EKOS catheter. Both catheters were sutured into place. A
heparin drip was initiated at the start of the procedure and the patient was
fully heparinized. Patient tolerated the procedure well and was taken to ICU
in good condition.
PROCEDURE PERFORMED:
1. Ultrasound-guided placement of sheaths x2 into left common femoral vein.
Permanent images were saved.
2. Pulmonary arteriogram bilaterally with selective catheterization of right
and left main pulmonary arteries. 36014 75743:26
3. Selective catheterization of right inferior pulmonary artery segmental
branch. 36015
4. Selective catheterization of right superior pulmonary artery segmental
branch. 36015
5. Tissue plasminogen activator instillation into right superior pulmonary
artery as well as the right inferior and middle lobe pulmonary artery.
6. Selective catheterization of right middle lobe pulmonary artery.
7. Selective catheterization of left superior and inferior lobe pulmonary
arteries with tissue plasminogen activator instillation into left inferior
pulmonary artery.
8. Initiation of thrombolytic therapy with 12 cm EKOS catheter placed into
ight main pulmonary artery and right inferior pulmonary artery.
9. A 6 cm EKOS catheter placement into left main and inferior pulmonary artery.
10. Inferior vena cavogram.
11. Selective catheterization of right common femoral and external iliac
arteries from a left femoral vein approach. 36012 36012 36012 75820:26
IVC 36010 venogram 75825:26
PROCEDURE IN DETAIL:
After appropriate informed consent was obtained, patient was brought to the
angiographic suite. A time-out was performed. Patient was identified. He
was laid supine. Left groin was prepped and draped in the usual sterile
manner. Right groin was ultrasounded and had an extensive DVT consistent with iliofemoral DVT. Ultrasound-guided access was performed with a micropuncture needle and micropuncture sheaths x2 placed in the left common femoral vein. Permanent images were stored.
Two initial 6-French short sheaths were placed.
An initial pigtail catheter was placed into the inferior vena cava and an
inferior vena cavogram was taken. Inferior vena cavogram demonstrated a
atent left external iliac and common iliac veins with patent inferior vena
cava. The catheter was then used to select out the right common femoral vein and right external and common iliac veins. This showed thrombus within the right external iliac vein and common femoral vein consistent with the known iliofemoral DVT. Right internal iliac vein was patent with right to left
collaterals noted. There was no over thrombus or filling defect in the cava.
At this point, one of the 690 sheaths was exchanged out for a 670 Ansel
sheath. The Ansel sheath was placed into the inferior vena cava. A floppy
Glidewire was then used to gain access to the main pulmonary artery. Both
sheaths were then placed into the main pulmonary artery. A pigtail catheter
was placed into the right and left pulmonary arteries respectively and initial
pulmonary arteriograms were taken.
Initial pulmonary arteriogramsdemonstrated occlusive thrombus going into the right superior pulmonary artery, right middle pulmonary artery and right inferior pulmonary artery branches. The thrombus started out in the lobar branches and were occlusive of the segmental and subsegmental branches with diminished perfusion of the branches.
A decision was made to intervene and a Kumpe catheter was used to select out the right superior lobar and segmental branches, as well as the right inferior as well as middle lobar and segmental branches. TPA 2 mg was instilled into the junction of the right middle and inferior lobar pulmonary arteries and 2 mg of tPA was instilled to the right superior lobar pulmonary artery.
Once this was done, a 12 cm EKOS catheter was placed extending from the main right pulmonary artery into the inferior and middle lobe lobar branches. Next, selective catheterizations were performed of the left superior lingual and
inferior pulmonary arteries. This demonstrated significant thrombus burden in
the lingual and inferior branches. TPA 2 mg was instilled through the Kumpe
catheter. A 6 cm EKOS was then placed into the left pulmonary artery
extending into the middle and inferior branches. TPA was begun at 0.75 mg/h
through each EKOS catheter. Both catheters were sutured into place. A
heparin drip was initiated at the start of the procedure and the patient was
fully heparinized. Patient tolerated the procedure well and was taken to ICU
in good condition.
