amym
Guest
Would it be appropriate to code this as 93451-26, 36556 and not sure if I can bill for the temporary dialysis catheter, not sure of the code?
PROCEDURES PERFORMED:
-- Right heart catheterization.
-- Temporary Dialysis Catheter Insertion.
-- QR-Hemostasis with Manual Pressure.
-- Central Line Catheter Insertion.
HEMODYNAMICS: Hemodynamic assessment demonstrates moderately depressed
cardiac output, moderately to markedly elevated pulmonary capillary wedge
pressure, and moderately elevated pulmonary vascular resistance. There is
moderate biventricular failure.
PROCEDURE: The risks and alternatives of the procedures and conscious
sedation were explained to the patient and informed consent was obtained.
The patient was brought to the cath lab and placed on the table. The
planned puncture sites were prepped and draped in the usual sterile
fashion.
-- Right internal jugular vein access. The vessel was accessed, a wire
was threaded into the vessel, and a was advanced over the wire into the
vessel.
-- Right femoral vein access. The puncture site was infiltrated with
local anesthetic. The vessel was accessed using the modified Seldinger
technique, a wire was threaded into the vessel, and a sheath was advanced
over the wire into the vessel.
-- Right heart catheterization. A catheter was advanced to the pulmonary
artery wedge position.
-- Temporary Dialysis Catheter Insertion..The right femoral venous sheath
was replaced over a guidewire with a 19 cm Vascath using sterile
technique. The Vascath was secured to the skin using 3-0 Prolene suture
and a sterile dressing.
-- QR-Hemostasis with Manual Pressure..
-- Central Line Catheter Insertion..Right internal jugular central venous
catheter was placed using modified Seldinger technique in the right
internal jugular vein under fluoroscopic guidance. Catheter was secured to
the skin using 0 Silk suture and a sterile dressing.
COMPLICATIONS:
There were no adverse outcomes.
PROCEDURE COMPLETION: The patient tolerated the procedure well. TIMING:
Test started at 13:49. Test concluded at 14:53. RADIATION EXPOSURE:
Fluoroscopy time: 8.8 min.
MEDICATIONS GIVEN:
Existing Diprovan, infusion rate of 45 mcg/min, IV, at 13:37.
Existing Dopamine Drip, infusion rate of 10 mcg/kg/min, IV, at 13:38.
Lasix (Furosemide), 40 mg, IV, at 14:12.
1% Lidocaine, 4 ml, subcutaneously, at 14:18.
STUDY DIAGRAM
HEMODYNAMIC TABLES
Pressures: Baseline
Pressures: - HR: 116
Pressures: - Rhythm:
Pressures: -- Pulmonary Artery (S/D/M): 58/32/43
Pressures: -- Pulmonary Capillary Wedge: 32/37/30
Pressures: -- Right Atrium (a/v/M): 22/22/19
Pressures: -- Right Ventricle (s/edp): 53/20/--
O2 Sats: Baseline
O2 Sats: - HR: 116
O2 Sats: - Rhythm:
O2 Sats: -- AO: 10/87/11.83
O2 Sats: -- Pa: 10/41/5.66
O2 Sats: -- RA: 10/43/5.93
Outputs: Baseline
Outputs: -- CALCULATIONS: Age in years: 79.61
Outputs: -- CALCULATIONS: Average Partial Oxygen - MV: 28.00
Outputs: -- CALCULATIONS: Average Partial Oxygen - PA: 27.00
Outputs: -- CALCULATIONS: Body Surface Area: 2.09
Outputs: -- CALCULATIONS: Height in cm: 175.00
Outputs: -- CALCULATIONS: Sex: Male
Outputs: -- CALCULATIONS: Weight in kg: 93.90
Outputs: -- OUTPUTS: Blood Oxygen Difference: 5.90
Outputs: -- OUTPUTS: CO by Fick: 4.67
Outputs: -- OUTPUTS: Fick cardiac index: 2.23
Outputs: -- OUTPUTS: Fick HR: 116.00
Outputs: -- OUTPUTS: O2 consumption: 275.67
Outputs: -- OUTPUTS: Vo2 Indexed: 131.66
Outputs: -- RESISTANCES: Pulmonary vascular index (dsc): 487.81
Outputs: -- RESISTANCES: Pulmonary vascular index (Wood Units): 6.10
Outputs: -- RESISTANCES: Pulmonary vascular resistance (dsc): 232.97
Outputs: -- RESISTANCES: Pulmonary vascular resistance (Wood Units): 2.91
Outputs: -- RESISTANCES: Right ventricular stroke work: 12.35
Outputs: -- RESISTANCES: Right ventricular stroke work index: 5.90
Outputs: -- RESISTANCES: Total pulmonary index (dsc): 1613.52
Outputs: -- RESISTANCES: Total pulmonary index (Wood Units): 20.17
Outputs: -- RESISTANCES: Total pulmonary resistance (dsc): 770.59
Outputs: -- RESISTANCES: Total pulmonary resistance (Wood Units): 9.63
Outputs: -- SHUNTS: Pulmonary flow: 4.46
Outputs: -- SHUNTS: Qp Indexed: 2.13
Outputs: -- SHUNTS: Qs Indexed: 2.23
PROCEDURES PERFORMED:
-- Right heart catheterization.
-- Temporary Dialysis Catheter Insertion.
-- QR-Hemostasis with Manual Pressure.
-- Central Line Catheter Insertion.
HEMODYNAMICS: Hemodynamic assessment demonstrates moderately depressed
cardiac output, moderately to markedly elevated pulmonary capillary wedge
pressure, and moderately elevated pulmonary vascular resistance. There is
moderate biventricular failure.
PROCEDURE: The risks and alternatives of the procedures and conscious
sedation were explained to the patient and informed consent was obtained.
The patient was brought to the cath lab and placed on the table. The
planned puncture sites were prepped and draped in the usual sterile
fashion.
-- Right internal jugular vein access. The vessel was accessed, a wire
was threaded into the vessel, and a was advanced over the wire into the
vessel.
-- Right femoral vein access. The puncture site was infiltrated with
local anesthetic. The vessel was accessed using the modified Seldinger
technique, a wire was threaded into the vessel, and a sheath was advanced
over the wire into the vessel.
-- Right heart catheterization. A catheter was advanced to the pulmonary
artery wedge position.
-- Temporary Dialysis Catheter Insertion..The right femoral venous sheath
was replaced over a guidewire with a 19 cm Vascath using sterile
technique. The Vascath was secured to the skin using 3-0 Prolene suture
and a sterile dressing.
-- QR-Hemostasis with Manual Pressure..
-- Central Line Catheter Insertion..Right internal jugular central venous
catheter was placed using modified Seldinger technique in the right
internal jugular vein under fluoroscopic guidance. Catheter was secured to
the skin using 0 Silk suture and a sterile dressing.
COMPLICATIONS:
There were no adverse outcomes.
PROCEDURE COMPLETION: The patient tolerated the procedure well. TIMING:
Test started at 13:49. Test concluded at 14:53. RADIATION EXPOSURE:
Fluoroscopy time: 8.8 min.
MEDICATIONS GIVEN:
Existing Diprovan, infusion rate of 45 mcg/min, IV, at 13:37.
Existing Dopamine Drip, infusion rate of 10 mcg/kg/min, IV, at 13:38.
Lasix (Furosemide), 40 mg, IV, at 14:12.
1% Lidocaine, 4 ml, subcutaneously, at 14:18.
STUDY DIAGRAM
HEMODYNAMIC TABLES
Pressures: Baseline
Pressures: - HR: 116
Pressures: - Rhythm:
Pressures: -- Pulmonary Artery (S/D/M): 58/32/43
Pressures: -- Pulmonary Capillary Wedge: 32/37/30
Pressures: -- Right Atrium (a/v/M): 22/22/19
Pressures: -- Right Ventricle (s/edp): 53/20/--
O2 Sats: Baseline
O2 Sats: - HR: 116
O2 Sats: - Rhythm:
O2 Sats: -- AO: 10/87/11.83
O2 Sats: -- Pa: 10/41/5.66
O2 Sats: -- RA: 10/43/5.93
Outputs: Baseline
Outputs: -- CALCULATIONS: Age in years: 79.61
Outputs: -- CALCULATIONS: Average Partial Oxygen - MV: 28.00
Outputs: -- CALCULATIONS: Average Partial Oxygen - PA: 27.00
Outputs: -- CALCULATIONS: Body Surface Area: 2.09
Outputs: -- CALCULATIONS: Height in cm: 175.00
Outputs: -- CALCULATIONS: Sex: Male
Outputs: -- CALCULATIONS: Weight in kg: 93.90
Outputs: -- OUTPUTS: Blood Oxygen Difference: 5.90
Outputs: -- OUTPUTS: CO by Fick: 4.67
Outputs: -- OUTPUTS: Fick cardiac index: 2.23
Outputs: -- OUTPUTS: Fick HR: 116.00
Outputs: -- OUTPUTS: O2 consumption: 275.67
Outputs: -- OUTPUTS: Vo2 Indexed: 131.66
Outputs: -- RESISTANCES: Pulmonary vascular index (dsc): 487.81
Outputs: -- RESISTANCES: Pulmonary vascular index (Wood Units): 6.10
Outputs: -- RESISTANCES: Pulmonary vascular resistance (dsc): 232.97
Outputs: -- RESISTANCES: Pulmonary vascular resistance (Wood Units): 2.91
Outputs: -- RESISTANCES: Right ventricular stroke work: 12.35
Outputs: -- RESISTANCES: Right ventricular stroke work index: 5.90
Outputs: -- RESISTANCES: Total pulmonary index (dsc): 1613.52
Outputs: -- RESISTANCES: Total pulmonary index (Wood Units): 20.17
Outputs: -- RESISTANCES: Total pulmonary resistance (dsc): 770.59
Outputs: -- RESISTANCES: Total pulmonary resistance (Wood Units): 9.63
Outputs: -- SHUNTS: Pulmonary flow: 4.46
Outputs: -- SHUNTS: Qp Indexed: 2.13
Outputs: -- SHUNTS: Qs Indexed: 2.23