Please help! THROMBECTOMY VASC ACCESS DVC??

she803

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How should this be coded?? Originally it was 36005-59, 306010, 37187, 35476, 37205, 75820-59-26; 75825-59-26; 76937-26; 75978-26; 75960-26. However, I was instructed to change 36005-59 to 75960 and delete 76937-26--are these revisions correct?

History: 27-year-old male with left lower extremity DVT as well as IVC clot. Patient also has bilateral pulmonary emboli. Patient is undergoing thrombolytic therapy for the low extremity DVT.

Procedure: Informed consent was obtained.

Fluoroscopy time is 20 minutes.

Contrast used Isovue 300, 150 cc.

Patient was placed prone on the fluoroscopy table and the existing left popliteal fossae catheters and skin were prepped and draped in usual sterile fashion.

Initial contrast injection through the infusion catheter demonstrates there to be persistent thrombosis within the femoral and iliac veins.

The infusion catheter was removed over an Amplatz wire and replaced with the Trellis thrombectomy catheter.

Thrombectomy was then performed from the proximal IVC to the distal superficial femoral vein. 4 mg of t-PA was used for thrombolysis.


Following the performance of the thrombectomy, a 12 mm balloon was used to dilate the veins from the left iliac vein to the femoral vein.

Follow a venogram performed demonstrates there to be flow within the femoral vein, however there is persistent thromboses and stricturing at the iliac vein. This segment was then stented using a 12 mm x 90 mm Wallstent, stent was dilated using a 12 mm balloon.

Post stenting and angioplasty venogram performed through the sheath in the popliteal vein demonstrates there to the flow through the previously thrombosed veins including the femoral and iliac system. There is mild adherent residue clot noted along the length of the veins.

The catheters and sheath were then removed.

Patient was to be placed on intravenous heparin for the adherent clot.

Patient was transferred back to ICU in stable condition.

Impression: Status post thrombectomy, angioplasty and stenting of lower extremity venous thrombosis as above.
 
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