Hello again, I have a thrombectomy procedure that I would appreciate input for the coding scenario. Thank you in advance and
I appreciate your time. Also, the aspiration thrombectomy gave me pause in the impression.
I have 37184-50 for left and right arterial thrombectomies
36014-50 for selective catheterization left and right pulmonary arteries
75743 - angiogram bilateral pulmonary arteries
76937- ultrasound guidance
BILATERAL PULMONARY ANGIOGRAM, PRIMARY PERCUTANEOUS TRANSLUMINAL MECHANICAL THROMBECTOMY OF THE RIGHT PULMONARY ARTERY UNDER FLUOROSCOPIC GUIDANCE, PRIMARY PERCUTANEOUS TRANSLUMINAL MECHANICAL THROMBECTOMY OF THE LEFT PULMONARY ARTERY UNDER FLUOROSCOPIC GUIDANCE 8/20/2021
PRE-PROCEDURE DIAGNOSIS: Saddle embolus of the pulmonary artery with acute cor pulmonale
POST-PROCEDURE DIAGNOSIS: Saddle embolus of the pulmonary artery with acute cor pulmonale
PROCEDURES PERFORMED:
1. Limited ultrasound of the right groin.
2. Micropuncture needle access into the right common femoral vein under real-time ultrasound guidance.
3. Selective catheterization and arteriography of the right pulmonary artery.
4. Supervision and interpretation of right pulmonary arteriography.
5. Primary percutaneous transluminal mechanical thrombectomy of the right pulmonary artery under fluoroscopic guidance.
6. Post thrombectomy angiogram.
7. Selective catheterization and arteriography of the left pulmonary artery.
8. Supervision and interpretation of left pulmonary arteriography.
9. Primary percutaneous transluminal mechanical thrombectomy of the left pulmonary artery under fluoroscopic guidance.
10. Transcatheter hemodynamic assessment of the pulmonary artery before and after thrombectomy.
MEDICATIONS: 10 cc 1% lidocaine subcutaneous, 89 cc Omnipaque IV.
KERMA-AREA-PRODUCT (PKA): 142 Gy cm2
FINDINGS/TECHNIQUE:
Informed consent was obtained from the patient. The patient was placed supine on the fluoroscopy table and the right groin was prepped and draped using maximum sterile barrier technique. Ultrasound examination of the right groin was performed to evaluate for potential access sites, demonstrating patency of the common femoral vein. 1% lidocaine was administered subcutaneously and a small dermatotomy was made using an 11 blade. A micropuncture needle was advanced into the right common femoral vein under real-time ultrasound guidance, an image stored for the patient's records. The needle was exchanged over a microwire for a micropuncture sheath. Then an 8 French sheath was placed. A 5 French pigtail catheter was maneuvered up the IVC and through the right cardiac chambers to catheterize the right pulmonary artery. Right pulmonary angiography was performed, demonstrating filling defects in multiple lobar branches with poor opacification of upper lobe branches. Pulmonary artery pressures were obtained from the pigtail catheter, demonstrating a systolic pulmonary artery pressure of 40 mm Hg.
The pigtail catheter was removed over an Amplatz wire. The 8 French sheath was exchanged over the wire for a 24 French dry seal sheath. A Flowtriever 24 catheter was advanced over the wire to the right main pulmonary artery under fluoroscopic guidance in order to perform extirpation of matter from the right pulmonary artery via a percutaneous approach. This yielded a very long saddle embolus, which was removed from the patient. Post thrombectomy right pulmonary angiogram demonstrated filling of all pulmonary artery branches to the right lung.
Then the left pulmonary artery was selectively catheterized and left pulmonary angiography was performed, demonstrating a large nearly occlusive thrombus in a right lower lobe pulmonary artery branch.
A Flowtriever 24 catheter was advanced over the wire to the left lower lobe pulmonary artery under fluoroscopic guidance in order to perform extirpation of matter from the left pulmonary artery branch via a percutaneous approach. This yielded a moderate amount of thrombus, which was removed from the patient.
A pigtail catheter was advanced over the wire back to the left pulmonary artery. Post thrombectomy pulmonary artery pressures were obtained from the pigtail catheter, demonstrating a pulmonary artery systolic blood pressure of 19 mm Hg.
The sheath was removed and hemostasis achieved using a 0 silk Z stitch. A dressing was applied. The patient tolerated the procedure without any complications.
IMPRESSION:
BILATERAL PULMONARY ANGIOGRAPHY DEMONSTRATES MULTIPLE FILLING DEFECTS FROM EXTENSIVE PULMONARY EMBOLUS.
SUCCESSFUL FLUOROSCOPICALLY GUIDED EXTIRPATION OF MATTER FROM THE RIGHT PULMONARY ARTERY VIA A PERCUTANEOUS APPROACH AND FROM THE LEFT PULMONARY ARTERY VIA A PERCUTANEOUS APPROACH USING PERCUTANEOUS FLOWTRIEVER ASPIRATION THROMBECTOMY, WHICH YIELDED A LARGE AMOUNT OF THROMBUS.
PULMONARY ARTERY SYSTOLIC PRESSURES DROPPED FROM 40 MM TO 19 MM.
Lisa, COC
I appreciate your time. Also, the aspiration thrombectomy gave me pause in the impression.
I have 37184-50 for left and right arterial thrombectomies
36014-50 for selective catheterization left and right pulmonary arteries
75743 - angiogram bilateral pulmonary arteries
76937- ultrasound guidance
BILATERAL PULMONARY ANGIOGRAM, PRIMARY PERCUTANEOUS TRANSLUMINAL MECHANICAL THROMBECTOMY OF THE RIGHT PULMONARY ARTERY UNDER FLUOROSCOPIC GUIDANCE, PRIMARY PERCUTANEOUS TRANSLUMINAL MECHANICAL THROMBECTOMY OF THE LEFT PULMONARY ARTERY UNDER FLUOROSCOPIC GUIDANCE 8/20/2021
PRE-PROCEDURE DIAGNOSIS: Saddle embolus of the pulmonary artery with acute cor pulmonale
POST-PROCEDURE DIAGNOSIS: Saddle embolus of the pulmonary artery with acute cor pulmonale
PROCEDURES PERFORMED:
1. Limited ultrasound of the right groin.
2. Micropuncture needle access into the right common femoral vein under real-time ultrasound guidance.
3. Selective catheterization and arteriography of the right pulmonary artery.
4. Supervision and interpretation of right pulmonary arteriography.
5. Primary percutaneous transluminal mechanical thrombectomy of the right pulmonary artery under fluoroscopic guidance.
6. Post thrombectomy angiogram.
7. Selective catheterization and arteriography of the left pulmonary artery.
8. Supervision and interpretation of left pulmonary arteriography.
9. Primary percutaneous transluminal mechanical thrombectomy of the left pulmonary artery under fluoroscopic guidance.
10. Transcatheter hemodynamic assessment of the pulmonary artery before and after thrombectomy.
MEDICATIONS: 10 cc 1% lidocaine subcutaneous, 89 cc Omnipaque IV.
KERMA-AREA-PRODUCT (PKA): 142 Gy cm2
FINDINGS/TECHNIQUE:
Informed consent was obtained from the patient. The patient was placed supine on the fluoroscopy table and the right groin was prepped and draped using maximum sterile barrier technique. Ultrasound examination of the right groin was performed to evaluate for potential access sites, demonstrating patency of the common femoral vein. 1% lidocaine was administered subcutaneously and a small dermatotomy was made using an 11 blade. A micropuncture needle was advanced into the right common femoral vein under real-time ultrasound guidance, an image stored for the patient's records. The needle was exchanged over a microwire for a micropuncture sheath. Then an 8 French sheath was placed. A 5 French pigtail catheter was maneuvered up the IVC and through the right cardiac chambers to catheterize the right pulmonary artery. Right pulmonary angiography was performed, demonstrating filling defects in multiple lobar branches with poor opacification of upper lobe branches. Pulmonary artery pressures were obtained from the pigtail catheter, demonstrating a systolic pulmonary artery pressure of 40 mm Hg.
The pigtail catheter was removed over an Amplatz wire. The 8 French sheath was exchanged over the wire for a 24 French dry seal sheath. A Flowtriever 24 catheter was advanced over the wire to the right main pulmonary artery under fluoroscopic guidance in order to perform extirpation of matter from the right pulmonary artery via a percutaneous approach. This yielded a very long saddle embolus, which was removed from the patient. Post thrombectomy right pulmonary angiogram demonstrated filling of all pulmonary artery branches to the right lung.
Then the left pulmonary artery was selectively catheterized and left pulmonary angiography was performed, demonstrating a large nearly occlusive thrombus in a right lower lobe pulmonary artery branch.
A Flowtriever 24 catheter was advanced over the wire to the left lower lobe pulmonary artery under fluoroscopic guidance in order to perform extirpation of matter from the left pulmonary artery branch via a percutaneous approach. This yielded a moderate amount of thrombus, which was removed from the patient.
A pigtail catheter was advanced over the wire back to the left pulmonary artery. Post thrombectomy pulmonary artery pressures were obtained from the pigtail catheter, demonstrating a pulmonary artery systolic blood pressure of 19 mm Hg.
The sheath was removed and hemostasis achieved using a 0 silk Z stitch. A dressing was applied. The patient tolerated the procedure without any complications.
IMPRESSION:
BILATERAL PULMONARY ANGIOGRAPHY DEMONSTRATES MULTIPLE FILLING DEFECTS FROM EXTENSIVE PULMONARY EMBOLUS.
SUCCESSFUL FLUOROSCOPICALLY GUIDED EXTIRPATION OF MATTER FROM THE RIGHT PULMONARY ARTERY VIA A PERCUTANEOUS APPROACH AND FROM THE LEFT PULMONARY ARTERY VIA A PERCUTANEOUS APPROACH USING PERCUTANEOUS FLOWTRIEVER ASPIRATION THROMBECTOMY, WHICH YIELDED A LARGE AMOUNT OF THROMBUS.
PULMONARY ARTERY SYSTOLIC PRESSURES DROPPED FROM 40 MM TO 19 MM.
Lisa, COC
I'm excited that I'm understanding. Have a great day!!