ablythe
Networker
My doctor placed both an RVAD and an LVAD. How would you code for this? It looks like CCI edits prevent me from billing CPTs 33995 and 33990 together.
Thank you in advance.
Procedures
Impella Insertion (Arterial)
Venous Catheter Placement - Hemodialysis
Left Ventricular Pressure Measurement
Tandem Heart Insertion, RVAD
Access Site
The left internal jugular vein was accessed. Ultrasound guidance used. Sheath inserted in the left internal jugular vein. The right femoral artery was accessed. Ultrasound guidance used. The left femoral vein was accessed. Ultrasound guidance used. Sheath inserted in the right femoral artery. Comments: Impella sheath 14Fr. Sheath inserted in the left femoral vein. Sheath sutured in place in the left internal jugular vein. Comments: TandmHeart RVAD. Sheath sutured in place in the right femoral artery. Comments: Impella Sheath LVAD.
Conclusion & Plan
XXX with biventricular shock referred for Tandem RVAD and Impella CP placement.
We obtained access in the RCFA, LCFV, and LIJV under ultrasound and fluoroscopic guidance.
We used a 7Fr PAC to deliver an Amplatz wire into the RPA. We deployed the Protek Duo catheter into the main PA and initiated therapy at 45000 RPM with no issues.
We next placed an Impella CP via the RCFA access. There was good placement with flows >3.5 L/min.
We next placed an HD catheter in the LCFV.
Results discussed with Dr. Berg. Ms. Demers tolerated the procedure well and there was no complication.
I supervised the administration of conscious sedation for 60 minutes and the patient was in stable condition when I left the room.
Thank you in advance.
Procedures
Impella Insertion (Arterial)
Venous Catheter Placement - Hemodialysis
Left Ventricular Pressure Measurement
Tandem Heart Insertion, RVAD
Access Site
The left internal jugular vein was accessed. Ultrasound guidance used. Sheath inserted in the left internal jugular vein. The right femoral artery was accessed. Ultrasound guidance used. The left femoral vein was accessed. Ultrasound guidance used. Sheath inserted in the right femoral artery. Comments: Impella sheath 14Fr. Sheath inserted in the left femoral vein. Sheath sutured in place in the left internal jugular vein. Comments: TandmHeart RVAD. Sheath sutured in place in the right femoral artery. Comments: Impella Sheath LVAD.
Conclusion & Plan
XXX with biventricular shock referred for Tandem RVAD and Impella CP placement.
We obtained access in the RCFA, LCFV, and LIJV under ultrasound and fluoroscopic guidance.
We used a 7Fr PAC to deliver an Amplatz wire into the RPA. We deployed the Protek Duo catheter into the main PA and initiated therapy at 45000 RPM with no issues.
We next placed an Impella CP via the RCFA access. There was good placement with flows >3.5 L/min.
We next placed an HD catheter in the LCFV.
Results discussed with Dr. Berg. Ms. Demers tolerated the procedure well and there was no complication.
I supervised the administration of conscious sedation for 60 minutes and the patient was in stable condition when I left the room.