dadhich.girish
Guru
Hi:
I m new to coding sclerotherapy. Please advise what codes should I bill for direct-puncture venography of neck veins x3 (name not specified) and direct puncture sclerotherapy of same sites. He is using roadmapping and fluoroscopy. Any and all inputs are welcome.
Report:
Using fluoroscopic guidance, the right neck and supraclavicular components of the venous malformation were punctured using a 5-French ring access sheath with a central needle. The needle was removed from the sheath, and backflow of blood was noted in all 3 locations. Contrast injection was then made under digital road-map imaging to confirm the presence of the sheath within the vascular lakes of the venous malformation. Once secure position of the catheter/sheath was noted within the malformation, contrast injection was further made in order to create a road map of the vascular lakes involved with the venous malformation. Non-opacified absolute or dehydrated alcohol was then injected through the sheath in order to rinse the opacified contrast from the malformation. The clearing of the contrast from the malformation would indicate appropriate injection of alcohol into this malformation. A total of 60 mL of absolute, or dehydrated, alcohol was used in all 3 of these locations.
Following the completion of alcohol injection within the 3 punctured components of the venous malformation, a collagen preparation with saline was then injected through the sheath as it was withdrawn from the vascular lake. In addition, direct digital pressure was applied to the puncture sites until hemostasis was achieved. The puncture sites appeared to increase in size and firmness and showed reddish and bluish discoloration of the skin, all indicative of an inflammatory response with marked tissue edema following the injection of the sclerosing agent.
Regards,
I m new to coding sclerotherapy. Please advise what codes should I bill for direct-puncture venography of neck veins x3 (name not specified) and direct puncture sclerotherapy of same sites. He is using roadmapping and fluoroscopy. Any and all inputs are welcome.
Report:
Using fluoroscopic guidance, the right neck and supraclavicular components of the venous malformation were punctured using a 5-French ring access sheath with a central needle. The needle was removed from the sheath, and backflow of blood was noted in all 3 locations. Contrast injection was then made under digital road-map imaging to confirm the presence of the sheath within the vascular lakes of the venous malformation. Once secure position of the catheter/sheath was noted within the malformation, contrast injection was further made in order to create a road map of the vascular lakes involved with the venous malformation. Non-opacified absolute or dehydrated alcohol was then injected through the sheath in order to rinse the opacified contrast from the malformation. The clearing of the contrast from the malformation would indicate appropriate injection of alcohol into this malformation. A total of 60 mL of absolute, or dehydrated, alcohol was used in all 3 of these locations.
Following the completion of alcohol injection within the 3 punctured components of the venous malformation, a collagen preparation with saline was then injected through the sheath as it was withdrawn from the vascular lake. In addition, direct digital pressure was applied to the puncture sites until hemostasis was achieved. The puncture sites appeared to increase in size and firmness and showed reddish and bluish discoloration of the skin, all indicative of an inflammatory response with marked tissue edema following the injection of the sclerosing agent.
Regards,
