Shirleybala
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Hi
How to code this report, my codes are
36120
36569
77001 26
76937 26
Procedure: Informed consent was obtained prior to the procedure.
Risks discussed included but were not limited to bleeding,
infection, venous thrombosis etc... A preliminary ultrasound
scan of the right upper arm was performed demonstrating patent
brachial and basilic veins. With the patient in the supine
position the right upper arm was prepped and draped in a sterile
fashion and the skin and subcutaneous tissues were infiltrated
with local Lidocaine. Under real-time sonographic guidance, the
right brachial artery was inadvertently punctured, and over a
wire, a 4.5-French peel-away sheath was placed. Under
fluoroscopic guidance, evaluation of the wire demonstrates an
arterial location. Subsequently, the 4.5-French peel-away sheath
was removed. Hemostasis was achieved after 30 minutes of manual
compression to the brachial artery. Follow-up sonographic
evaluation demonstrates a patent artery without evidence of
periarterial hematoma.
Subsequently, under real time ultrasound guidance, the right
basilic vein was punctured with a 21 gauge needle. A permanent
recording was created for the patient's record. A 0.018 inch
guidewire was inserted through the needle which was exchanged for
a 4.5 French peel-away sheath. A 4 French single lumen Power PICC
catheter was then cut to 41 cm length and inserted through the
peel-away sheath and advanced to the chest. The catheter tip was
positioned at the junction of the superior vena cava and right
atrium. The peel-away sheath was removed. The catheter was
flushed with Heplock solution and secured to the skin with 2-0
prolene sutures. A sterile dressing was applied.
The patient tolerated the procedure well. Total fluoroscopy time
was 0.7 minutes. No intravenous contrast material was utilized.
Impression:
Inadvertent puncture of the right brachial artery with placement
of a 4.5-French peel-away sheath. The sheath was withdrawn, and
hemostasis achieved with manual compression. The patient's right
arm was immobilized for 6 hours after PICC line insertion.
Ultrasound and fluoroscopy guided placement of a 4 French 41 cm
long single lumen Bard Power PICC catheter inserted through the
right basilic vein without complication.
How to code this report, my codes are
36120
36569
77001 26
76937 26
Procedure: Informed consent was obtained prior to the procedure.
Risks discussed included but were not limited to bleeding,
infection, venous thrombosis etc... A preliminary ultrasound
scan of the right upper arm was performed demonstrating patent
brachial and basilic veins. With the patient in the supine
position the right upper arm was prepped and draped in a sterile
fashion and the skin and subcutaneous tissues were infiltrated
with local Lidocaine. Under real-time sonographic guidance, the
right brachial artery was inadvertently punctured, and over a
wire, a 4.5-French peel-away sheath was placed. Under
fluoroscopic guidance, evaluation of the wire demonstrates an
arterial location. Subsequently, the 4.5-French peel-away sheath
was removed. Hemostasis was achieved after 30 minutes of manual
compression to the brachial artery. Follow-up sonographic
evaluation demonstrates a patent artery without evidence of
periarterial hematoma.
Subsequently, under real time ultrasound guidance, the right
basilic vein was punctured with a 21 gauge needle. A permanent
recording was created for the patient's record. A 0.018 inch
guidewire was inserted through the needle which was exchanged for
a 4.5 French peel-away sheath. A 4 French single lumen Power PICC
catheter was then cut to 41 cm length and inserted through the
peel-away sheath and advanced to the chest. The catheter tip was
positioned at the junction of the superior vena cava and right
atrium. The peel-away sheath was removed. The catheter was
flushed with Heplock solution and secured to the skin with 2-0
prolene sutures. A sterile dressing was applied.
The patient tolerated the procedure well. Total fluoroscopy time
was 0.7 minutes. No intravenous contrast material was utilized.
Impression:
Inadvertent puncture of the right brachial artery with placement
of a 4.5-French peel-away sheath. The sheath was withdrawn, and
hemostasis achieved with manual compression. The patient's right
arm was immobilized for 6 hours after PICC line insertion.
Ultrasound and fluoroscopy guided placement of a 4 French 41 cm
long single lumen Bard Power PICC catheter inserted through the
right basilic vein without complication.
