margaret fahy
Guru
Guys, How would you code this one? Would it be...36568, 77001, and 76937 only, as the venogram was done via saphenous, and saphenous was the insertion site. Dr. doesn't document tunneling in saphenous vein.
PROCEDURE:
A limited ultrasound of the right groin was performed to choose a
site for insertion of the non-cuffed central line. The right
femoral vein was chosen, and the skin overlying site was marked.
The skin of the right thigh was prepped and draped in sterile
fashion, and local anesthesia using 1% Lidocaine was injected at
the thigh insertion site. Using real-time ultrasound guidance, a
21G 7cm needle was inserted at the thigh region and the right
femoral vein was punctured in the groin region after creating a
subcutaneous tunnel. Once venous blood was obtained a 0.014"
Nitrex wire was placed into the vein. The wire could not passed
easily and there was resistance noted.
Hence a venogram was performed after accessing the saphenous vein
under ultrasound guidance. Venogram showed occlusion of the
common iliac vein with few collateral veins and the saphenous
vein was draining into the iliac vein through one of the
collateral veins.
A venogram roadmap was performed and utilizing the roadmap, a
0.014" Hi-Torque floppy wire was advanced into the right atrium.
A small dermatotomy was made, the tract was dilated, and a 3 F
peel-away sheath was placed into the vein. The distance to the
cavo-atrial junction was measured and a 2.6 F double lumen PICC
was cut to 20 cm. Via the peel-away sheath the PICC was placed
into the vein and advanced with fluoroscopic guidance until the
tip was at the IVC/RA junction. The peel-away sheath was then
removed. The catheter was fixed to the skin with a Stat-Lock
device, and a sterile occlusive dressing was applied. The
catheter aspirated and flushed easily and was heparinized. There
were no complications, and the patient left the IR suite in
stable condition. Dr. was present for the entire
procedure.
FINDINGS: A limited ultrasound of the right leg showed a patent
femoral and saphenous vein. A fluoroscopic image taken at the
end of the procedure showed the catheter tip to be at the IVC/RA
junction.
Venogram showed occlusion of the caudal portion of the common
femoral vein with collaterals.
Permanent ultrasound and fluoroscopic images were obtained and
stored in the PACS system.
IMPRESSION
Successful placement of a 20 cm,2.6 F double lumen
PICC via the right saphenous vein with tip at the IVC/RA
junction.
Occlusion of the caudal portion
PROCEDURE:
A limited ultrasound of the right groin was performed to choose a
site for insertion of the non-cuffed central line. The right
femoral vein was chosen, and the skin overlying site was marked.
The skin of the right thigh was prepped and draped in sterile
fashion, and local anesthesia using 1% Lidocaine was injected at
the thigh insertion site. Using real-time ultrasound guidance, a
21G 7cm needle was inserted at the thigh region and the right
femoral vein was punctured in the groin region after creating a
subcutaneous tunnel. Once venous blood was obtained a 0.014"
Nitrex wire was placed into the vein. The wire could not passed
easily and there was resistance noted.
Hence a venogram was performed after accessing the saphenous vein
under ultrasound guidance. Venogram showed occlusion of the
common iliac vein with few collateral veins and the saphenous
vein was draining into the iliac vein through one of the
collateral veins.
A venogram roadmap was performed and utilizing the roadmap, a
0.014" Hi-Torque floppy wire was advanced into the right atrium.
A small dermatotomy was made, the tract was dilated, and a 3 F
peel-away sheath was placed into the vein. The distance to the
cavo-atrial junction was measured and a 2.6 F double lumen PICC
was cut to 20 cm. Via the peel-away sheath the PICC was placed
into the vein and advanced with fluoroscopic guidance until the
tip was at the IVC/RA junction. The peel-away sheath was then
removed. The catheter was fixed to the skin with a Stat-Lock
device, and a sterile occlusive dressing was applied. The
catheter aspirated and flushed easily and was heparinized. There
were no complications, and the patient left the IR suite in
stable condition. Dr. was present for the entire
procedure.
FINDINGS: A limited ultrasound of the right leg showed a patent
femoral and saphenous vein. A fluoroscopic image taken at the
end of the procedure showed the catheter tip to be at the IVC/RA
junction.
Venogram showed occlusion of the caudal portion of the common
femoral vein with collaterals.
Permanent ultrasound and fluoroscopic images were obtained and
stored in the PACS system.
IMPRESSION
Successful placement of a 20 cm,2.6 F double lumen
PICC via the right saphenous vein with tip at the IVC/RA
junction.
Occlusion of the caudal portion