Tonyj
True Blue
We're having a discussion on the proper way to bill this procedure. Please review the abbreviated note and provide feed back.
PREOPERATIVE DIAGNOSIS: *SPINAL DURAL ARTERIOVENOUS FISTULA STATUS
POST PARTIAL EMBOLIZATION IN THE OUTSIDE HOSPITAL WITH PROGRESSIVE
LOWER EXTREMITIES WEAKNESS AND INCONTINENCE
*
POSTOPERATIVE DIAGNOSIS: RESIDUAL DURAL ARTERIOVENOUS FISTULA WITH
SINGLE INTRA DURAL DRAINING VEIN AT T6 LEVEL. FEEDING ARTERIES ARE
RECONSTITUTED FROM RIGHT T5 AND LEFT T6 INTERCOSTAL ARTERIES.
SIGNIFICANT DILATED VEINS ABOVE T6 VERTEBRAE LEVEL IS VISUALIZED.
ADAMKIEWICZ ARTERY IS POSSIBLY VISUALIZED FROM LEFT T6
*
OPERATION: FEMORAL SPINAL ANGIOGRAM
*
ANESTHESIA: MAC
*
COMPLICATIONS: NONE
*
ESTIMATED BLOOD LOSS: *10 CC
*
STUDIED VESSELS: RIGHT VERTEBRAL ARTERY, RIGHT SUBCLAVIAN ARTERY,
LEFT VERTEBRAL ARTERY, LEFT SUBCLAVIAN ARTERY, RIGHT THYROCERVICAL,
LEFT THYROCERVICAL, RIGHT INTERCOSTAL/RADICULAR ARTERIES (T3/4, T5,
T8, T9, T10, T11, T12, L1, L2, L3), LEFT INTERCOSTAL/RADICULAR
ARTERIES (T4, T5, T6, T7, T8, T9, T10, T11, T12, L2, L3)
*
INDICATIONS: *The patient is an 63 years year old Male with history
of progressive bilateral lower extremity numbness and weakness that
became substantially progressive since May of 2017, which led to an
MRI that raised the concern for a spinal dAVF. He was treated
partially with endovascular embolization in XXXX. He now has a
foley catheter and has severe (2/5 on the right and 3/5 on the left)
weakness in lower extremities.
SUPERVISION AND INTERPRETATION:
1. *Angiographic study demonstrates residual dural arteriovenous
fistula at the level of T6. This is supplied by right T5 and left T6
intercostal arteries. Significant dilated spinal veins are visualized
above T6 level.
2. * The artery of Adamkiewecz is possibly visualized in the Left T6
intercostal artery run.
2. *No immediate complications.
*
VESSELS STUDIED:
1. *Right Vertebral Artery
2. *Right Subclavian Artery
3. *Right T3/4
4. *Right T5
5. *Right T8
6. *Right T9
7. *Right T10
8. *Right T11
9. *Right T12
10. *Right L1
11. *Right L2
12. *Right L3
13. *Left Vertebral Artery
14. *Left Subclavian Artery
15. *Left T4
16. *Left T5
17. *Left T6
18. *Left T7
19. *Left T8
20. *Left T9
21. *Left T10
22. *Left T11
23. *Left T12
24. *Left L2
25. *Left L3
26. *Right common femoral artery.
Coded as such;
36226-50
36215 x 6
36216 x 2
36245-50 x 3
Would appreciate any and all input from forum.
PREOPERATIVE DIAGNOSIS: *SPINAL DURAL ARTERIOVENOUS FISTULA STATUS
POST PARTIAL EMBOLIZATION IN THE OUTSIDE HOSPITAL WITH PROGRESSIVE
LOWER EXTREMITIES WEAKNESS AND INCONTINENCE
*
POSTOPERATIVE DIAGNOSIS: RESIDUAL DURAL ARTERIOVENOUS FISTULA WITH
SINGLE INTRA DURAL DRAINING VEIN AT T6 LEVEL. FEEDING ARTERIES ARE
RECONSTITUTED FROM RIGHT T5 AND LEFT T6 INTERCOSTAL ARTERIES.
SIGNIFICANT DILATED VEINS ABOVE T6 VERTEBRAE LEVEL IS VISUALIZED.
ADAMKIEWICZ ARTERY IS POSSIBLY VISUALIZED FROM LEFT T6
*
OPERATION: FEMORAL SPINAL ANGIOGRAM
*
ANESTHESIA: MAC
*
COMPLICATIONS: NONE
*
ESTIMATED BLOOD LOSS: *10 CC
*
STUDIED VESSELS: RIGHT VERTEBRAL ARTERY, RIGHT SUBCLAVIAN ARTERY,
LEFT VERTEBRAL ARTERY, LEFT SUBCLAVIAN ARTERY, RIGHT THYROCERVICAL,
LEFT THYROCERVICAL, RIGHT INTERCOSTAL/RADICULAR ARTERIES (T3/4, T5,
T8, T9, T10, T11, T12, L1, L2, L3), LEFT INTERCOSTAL/RADICULAR
ARTERIES (T4, T5, T6, T7, T8, T9, T10, T11, T12, L2, L3)
*
INDICATIONS: *The patient is an 63 years year old Male with history
of progressive bilateral lower extremity numbness and weakness that
became substantially progressive since May of 2017, which led to an
MRI that raised the concern for a spinal dAVF. He was treated
partially with endovascular embolization in XXXX. He now has a
foley catheter and has severe (2/5 on the right and 3/5 on the left)
weakness in lower extremities.
SUPERVISION AND INTERPRETATION:
1. *Angiographic study demonstrates residual dural arteriovenous
fistula at the level of T6. This is supplied by right T5 and left T6
intercostal arteries. Significant dilated spinal veins are visualized
above T6 level.
2. * The artery of Adamkiewecz is possibly visualized in the Left T6
intercostal artery run.
2. *No immediate complications.
*
VESSELS STUDIED:
1. *Right Vertebral Artery
2. *Right Subclavian Artery
3. *Right T3/4
4. *Right T5
5. *Right T8
6. *Right T9
7. *Right T10
8. *Right T11
9. *Right T12
10. *Right L1
11. *Right L2
12. *Right L3
13. *Left Vertebral Artery
14. *Left Subclavian Artery
15. *Left T4
16. *Left T5
17. *Left T6
18. *Left T7
19. *Left T8
20. *Left T9
21. *Left T10
22. *Left T11
23. *Left T12
24. *Left L2
25. *Left L3
26. *Right common femoral artery.
Coded as such;
36226-50
36215 x 6
36216 x 2
36245-50 x 3
Would appreciate any and all input from forum.