margaret fahy
Guru
Can we bill 10030 for placement of the drains (left in place for subsequent Sclero injxns.)....there is an MUE of 2 for 10030 for one DOS. If one can bill for catheter placements, it seems to follow that the drain placements can be billed. I know for 49485, drain placement is also billable. 37241 and 10030....
PROCEDURE: SCLEROTHERAPY LYMPHATIC MALFORMATION
HISTORY: 17 day old male with large congenital lymphatic
malformation of the neck and lower face.
PROCEDURE:
The extensive neck lymphatic malformation was examined with
ultrasound and a suitable access site for needle placement was
identified and the skin marked. The neck and lower face and
upper chest were prepared and draped in the usual sterile
fashion.
Using ultrasound guidance several macrocysts were accessed and
four 6 French pigtail drains were placed using the trocar
technique. Multiple adjacent loculated collections were
transversed. With each drain placement.
Contrast injection was mixed with saline and Doxycycline at a
concentration of 10mg/ml and injected under US and fluoroscopy
into each drain as follows:
Site Summary:
Drain 1 output 17.8mls , Doxycycline 60mg 6mls
Drain 2 output 10.2mls, Doxycycline 50mg, 5mls
Drain 3 output 11.7mls, Doxycycline 100mg, 10mls
Drain 4, output 10mls, Doxycycline 9omg, 9mls
A total of 300 mg doxycycline was injected.
Permanent ultrasound and fluoroscopic images were obtained and
stored in the PACS system.
FINDINGS: Initial ultrasound revealed a predominantly macrocystic
transfacial lymphatic malformation in the right neck, extending
into the retropharyngeal space posterior to the airway. This
component was specifically targeted for sclerotherapy. Ultrasound
images demonstrated appropriate filling of this component with
agitated doxycycline but non-intercalation of the medication into
larger more superficial components of the malformation.
Postinjection ultrasound and fluoroscopic images revealed
appropriate global distribution of the medication throughout the
malformation.
Permanent US and fluoroscopic images were obtained and stored in
the PACS system.
IMPRESSION:
Successful 4 site catheter Doxycycline sclerotherapy of the a
predominantly macrocystic lymphatic malformation with
fluoroscopic and ultrasound guidance.
PROCEDURE: SCLEROTHERAPY LYMPHATIC MALFORMATION
HISTORY: 17 day old male with large congenital lymphatic
malformation of the neck and lower face.
PROCEDURE:
The extensive neck lymphatic malformation was examined with
ultrasound and a suitable access site for needle placement was
identified and the skin marked. The neck and lower face and
upper chest were prepared and draped in the usual sterile
fashion.
Using ultrasound guidance several macrocysts were accessed and
four 6 French pigtail drains were placed using the trocar
technique. Multiple adjacent loculated collections were
transversed. With each drain placement.
Contrast injection was mixed with saline and Doxycycline at a
concentration of 10mg/ml and injected under US and fluoroscopy
into each drain as follows:
Site Summary:
Drain 1 output 17.8mls , Doxycycline 60mg 6mls
Drain 2 output 10.2mls, Doxycycline 50mg, 5mls
Drain 3 output 11.7mls, Doxycycline 100mg, 10mls
Drain 4, output 10mls, Doxycycline 9omg, 9mls
A total of 300 mg doxycycline was injected.
Permanent ultrasound and fluoroscopic images were obtained and
stored in the PACS system.
FINDINGS: Initial ultrasound revealed a predominantly macrocystic
transfacial lymphatic malformation in the right neck, extending
into the retropharyngeal space posterior to the airway. This
component was specifically targeted for sclerotherapy. Ultrasound
images demonstrated appropriate filling of this component with
agitated doxycycline but non-intercalation of the medication into
larger more superficial components of the malformation.
Postinjection ultrasound and fluoroscopic images revealed
appropriate global distribution of the medication throughout the
malformation.
Permanent US and fluoroscopic images were obtained and stored in
the PACS system.
IMPRESSION:
Successful 4 site catheter Doxycycline sclerotherapy of the a
predominantly macrocystic lymphatic malformation with
fluoroscopic and ultrasound guidance.