csorensen21@yahoo.com
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I am new to this aspect of coding. Need some other set of eyes for help!
Access: Right Femoral Vein Access
Procedure(s):
1. IVC Venography, right femoral and right iliac venography
2. Left femoral/Iliac vein Angiography
3. Right Main PA Pulmonary Embolism Mechanical Arterial Extirpation of Matter
4. Right Heart catheterization
5. Moderate Sedation
Brief Clinical history:
PERT was consulted and recommended escalation of care with invasive mechanical aspiration thrombectomy. Pt had a saddle embolus with high risk features.
Procedural Details:
After obtaining written informed consent, the patient was draped and prepped in the usual sterile manner. Conscious sedation was administered monitored by anesthesia. Heparin IV was given.
1. Access: Using micropuncture technique, local anesthetic was given and access was obtained in the right femoral vein. An 8F short sheath was placed and an IVC venogram was performed. This revealed thrombus in the right common iliac vein. We obtained access from the left femoral vein and angiography revealed patency of the left femoral vein and IVC before placing the 24F Intri sheath. T
2. Diagnostic: A 7FR Baim Turi were used to position the wires in the right pulmonary arteries and we measured pulmonary pressures.
A regular J and Super Stiff Amplatz wire was used to assist the T24 catheter to get to the right position in the right/left mauin/interlobar PA as needed.
3. Intervention (Bilateral Flowtriever Mechanical Extirpation of Matter with use of the T24 Flowtriever Catheter):
We proceeded with thromboembolectomy immediately. We aspirated twice through the T24 cqtheter and only a small amount of blood came out indication thrombus occluded the catheter.
With the negative pressure on,the catheter was pulled back out of the sheath. Relatively small amounts of thrombus was retrieved, but we noted that despite suction the sheath had occluded as well. We lled the sheath back under suction and a huge thrombus was retrived from inside the sheath.
The sheath was reintroduced and using the same stiff Amplatz wire access we took the T24 catheter to the main R PA.
Final Angiography showed improved blush and no further thrombus burden.
Repeat PA pressure were measured and showed significant reduction therefore the procedure was completed.
The catheter was removed over the wire.
4. Hemostasis: The 24F Intri sheath was removed and figure of 8 suture with a flow-stasis suture retention device was applied for hemostasis.
The R femoral vein 8F sheath was closed with mynx.
5. Blood loss approx: 20-50 cc
Key Findings:
1. HEMODYNAMICS
A. Right heart catheterization
1. Pre Embolectomy RA 10 (18/23), RV 40/13/, PA 40/13 (23), mean 23 mmHg, 2: Post Embolectomy PA Not measured
2. Pulmonary Angiography, pre thrombectomy: Not done
3. Pulmonary Angiography: post thrombectomy
A. Right Main PA - widely patent, good blush
B. Right TA - widely patent, good blush
C. Right IA - widely patent, good blush
D. Left TA - patent, good blush
E. Left IA Pulmonary Artery - patent, good blush
4. IVC Venography
Patent vessel, no thrombus visualized
Complications: none
Radiation: 600 mGy
TECHNICAL FACTORS
Sedation: 50 mg Versed, 1 mcg of Fentanyl
Medications: 2000 units heparin (already on IV)
Contrast: 40 cc of Isovue.
EBL: 20-50cc
Conscious sedation: Conscious sedation was administered by qualified nursing personnel under continuous hemodynamic monitoring, starting at //2023 1:25 PM and ending at //2023 2:31 PM.
Impression:
1. Intermediate-High Risk Pulmonary Embolism
2. Successful bilateral Pulmonary Embolectomy with 24F Flowtriever with an initial systolic PA pressure from 40 mmHg
Plan:
1. Continue IV Heparin gtt for 12 hours and with plan to change to DOAC if there are no bleeding complications
2. Monitor in CCU
3. TTE in the am
I am seeing 37184, 75825, 99152 but can I code 93451 here?
Access: Right Femoral Vein Access
Procedure(s):
1. IVC Venography, right femoral and right iliac venography
2. Left femoral/Iliac vein Angiography
3. Right Main PA Pulmonary Embolism Mechanical Arterial Extirpation of Matter
4. Right Heart catheterization
5. Moderate Sedation
Brief Clinical history:
PERT was consulted and recommended escalation of care with invasive mechanical aspiration thrombectomy. Pt had a saddle embolus with high risk features.
Procedural Details:
After obtaining written informed consent, the patient was draped and prepped in the usual sterile manner. Conscious sedation was administered monitored by anesthesia. Heparin IV was given.
1. Access: Using micropuncture technique, local anesthetic was given and access was obtained in the right femoral vein. An 8F short sheath was placed and an IVC venogram was performed. This revealed thrombus in the right common iliac vein. We obtained access from the left femoral vein and angiography revealed patency of the left femoral vein and IVC before placing the 24F Intri sheath. T
2. Diagnostic: A 7FR Baim Turi were used to position the wires in the right pulmonary arteries and we measured pulmonary pressures.
A regular J and Super Stiff Amplatz wire was used to assist the T24 catheter to get to the right position in the right/left mauin/interlobar PA as needed.
3. Intervention (Bilateral Flowtriever Mechanical Extirpation of Matter with use of the T24 Flowtriever Catheter):
We proceeded with thromboembolectomy immediately. We aspirated twice through the T24 cqtheter and only a small amount of blood came out indication thrombus occluded the catheter.
With the negative pressure on,the catheter was pulled back out of the sheath. Relatively small amounts of thrombus was retrieved, but we noted that despite suction the sheath had occluded as well. We lled the sheath back under suction and a huge thrombus was retrived from inside the sheath.
The sheath was reintroduced and using the same stiff Amplatz wire access we took the T24 catheter to the main R PA.
Final Angiography showed improved blush and no further thrombus burden.
Repeat PA pressure were measured and showed significant reduction therefore the procedure was completed.
The catheter was removed over the wire.
4. Hemostasis: The 24F Intri sheath was removed and figure of 8 suture with a flow-stasis suture retention device was applied for hemostasis.
The R femoral vein 8F sheath was closed with mynx.
5. Blood loss approx: 20-50 cc
Key Findings:
1. HEMODYNAMICS
A. Right heart catheterization
1. Pre Embolectomy RA 10 (18/23), RV 40/13/, PA 40/13 (23), mean 23 mmHg, 2: Post Embolectomy PA Not measured
2. Pulmonary Angiography, pre thrombectomy: Not done
3. Pulmonary Angiography: post thrombectomy
A. Right Main PA - widely patent, good blush
B. Right TA - widely patent, good blush
C. Right IA - widely patent, good blush
D. Left TA - patent, good blush
E. Left IA Pulmonary Artery - patent, good blush
4. IVC Venography
Patent vessel, no thrombus visualized
Complications: none
Radiation: 600 mGy
TECHNICAL FACTORS
Sedation: 50 mg Versed, 1 mcg of Fentanyl
Medications: 2000 units heparin (already on IV)
Contrast: 40 cc of Isovue.
EBL: 20-50cc
Conscious sedation: Conscious sedation was administered by qualified nursing personnel under continuous hemodynamic monitoring, starting at //2023 1:25 PM and ending at //2023 2:31 PM.
Impression:
1. Intermediate-High Risk Pulmonary Embolism
2. Successful bilateral Pulmonary Embolectomy with 24F Flowtriever with an initial systolic PA pressure from 40 mmHg
Plan:
1. Continue IV Heparin gtt for 12 hours and with plan to change to DOAC if there are no bleeding complications
2. Monitor in CCU
3. TTE in the am
I am seeing 37184, 75825, 99152 but can I code 93451 here?