Wiki Placement of infusion cath for thrombolysis VASCULAR CODERS HELP PLEASE!

[nlbarnes]

I think I'm wrong on a couple of codes. I've got:

75978
35476
36012
75820
37212
75978
77001?

POSTOPERATIVE DIAGNOSIS:
Paget-Schroetter syndrome of right subclavian vein.

PROCEDURES:
1. Venogram, right upper extremity.
2. Venoplasty of right subclavian vein.
3. Placement of infusion catheter for thrombolysis.
4. Ultrasound-guided access of right basilic vein.
5. Diagnosis and interpretation of above.

OPERATIVE FINDINGS:
Patent basilic vein with thrombus noted in right axillary and
subclavian vein. Patent superior vena cava.

DESCRIPTION OF PROCEDURE:
The right arm was anesthetized under ultrasound guidance above the basilic vein. A
small nick in the skin was made with an 11 blade. The basilic vein
was attempted to be accessed, but a wire could not be passed at the
site of initial venipuncture. A second area was anesthetized under
local anesthesia and ultrasound guidance and more proximally on the
vein, and this was successfully accessed using the micropuncture
catheter kit and needle. The micropuncture catheter was up-sized to a
6-French sheath over a J-wire. A KMP catheter was placed into the
distal basilic vein after an initial venogram was shot and subsequent
venography was performed through the KMP catheter. A Glidewire was
used to cross a portion of the occluded vein, but could not cross with
the KMP alone. A Seeker catheter in conjunction with the Glidewire
was able to successfully traverse the thrombus and occlusion of the
right subclavian vein. The Glidewire was then exchanged for a
Supracore wire. A 5 mm x 80 mm balloon was used to perform venoplasty
of the axillary and subclavian vein. This demonstrated patency
without evidence of extravasation. A 10 cm multi-sideport infusion
catheter was then placed across the subclavian vein and axillary vein,
and extended into the initial portion of the superior vena cava. This
infusion catheter was then secured in place as was a 6-French sheath
with a single silk suture and dressing. The infusion catheter was
hooked up to a tPA infusion line, and the sideport of the sheath was
hooked up to a heparin infusion line. The patient was awakened and
transferred to the intensive care unit to undergo overnight
thrombolysis of her chronic-appearing right subclavian vein clot.

 

[whittyamy]

36010 final catheter placement in SVC
37212 Thrombolysis
75820 venogram

It is not clear if the angioplasty was performed in order to place the infusion catheter ( would not be billable) or if that was the intent all along.

77001 can only be billed for CVC devices.

36012 is a selective catheter placement. He catheterized the right upper extremity and only went into the right subclavian and axillary so normally 36005 would be billed but since the infusion catheter lies in the SVC, 36010 would be billed.

I hope this helps.

 

[nlbarnes]

Placement of infusion catheter

Whittyamy, thank you for your help. I have another question. A coworker told me that 76937 is never used in our vascular cases, i.e., Removal of tunneled cath, cath of superior vena cava, perc trans venoplasty for one. Bil iliofemoral venogram, angioplasty, & stenting. I could post an op report next time I get one that the doc wants to charge 96397 if my question can't be answered without.

Thanks!

 

[nlbarnes]

76937 & 77001

I have a report now where the surgeon is using both 77001 & 76937 (x2) for 36561. Can both 77001 & 76937 be billed w/ 36561?

PROCEDURES:
1. Ultrasound-guided percutaneous access of right internal jugular
vein.
2. Placement of 6-French Port-A-Cath into the right internal jugular
vein terminating the right anterior chest wall.
3. Completion fluoroscopy for confirmation of intravascular device
placement.
4. Supervision and interpretation of above.

ultrasound was
used to percutaneously access the right internal jugular vein after
which guidewire and sheath were placed in the vein without difficulty.
An 11 blade was used to create a counterincision at this site, which
was dilated with hemostats. At this time, then local anesthetic was
infiltrated in the right anterior chest wall along the deltopectoral
groove, after which a 15 blade was used to create 2 cm skin incision.
Electrocautery, blunt, and sharp dissection was used to carry this
down through the subcutaneous tissues to level of the pectoralis
fascia after which blunt dissection was used to fashion a pocket for
the port overlying the pectoralis fascia. A tunneler was then used to
tunnel the catheter from the port pocket to the counterincision at the
neck without difficulty. The port was then affixed to the distal end
of the catheter using a locking sleeve to secure it in place. The
port was then sutured to the pectoralis fascia in an interrupted
fashion using 3-0 Ethibond sutures. The catheter was then pulled to
length and cut the appropriate length under fluoroscopic guidance. At
this time, an introducer sheath was tracked over the wire into the
internal jugular vein after which the catheter was threaded through
the sheath without difficulty. The peel-away sheath was removed and
fluoroscopy was used to confirm good catheter placement. The port was
then accessed and easily back bled and flushed with heparinized
saline. A Huber needle was then inserted percutaneously into the port