margaret fahy
Guru
Guys,
How am I to code for the SMV Venography?....
I also have 36481, 75885, 35476, 75978....
Can't find info on the SMV Venography....would it be 36011 or 36012 & ?...no more 75774, from what I've read?...
Exam: IR PTA Venous
IR Venogram Portal W/ Hemodynamics Completed: 05/08/2014 12:01 PM
05/08/2014 12:01 PM
Appt Loc: Main Interventional
Attending:
Indications:
Diagnosis:Status post liver transplantation [V42.7 (ICD-9-CM)]<br />Portal vein stenosis [459.2 (ICD-9-CM)]
Status post liver transplantation [V42.7 (ICD-9-CM)]<br />Portal vein stenosis [459.2 (ICD-9-CM)]
Reason:7 yo with hx of biliary atresia s/p liver transplant in 2007 with hx of portal vein stenosis, portal hypertension and esophageal varices/bleeding, s/p repeat angioplasty in IR
7 yo with hx of biliary atresia s/p liver transplant in 2007 with hx of portal vein stenosis, portal hypertension and esophageal varices/bleeding, s/p repeat angioplasty in IR
Interpretation:
PERCUTANEOUS PORTAL VEIN ANGIOPLASTY W PRESSURE MEASUREMENTS:
CLINICAL HISTORY: Gastric and esophageal varices, splenomegaly,
multiple variceal bleeds. s/p liver transplant. Prophylactic
portal vein angioplasty as patient has bled at interval of 1 yr
post prior angioplasty. To date no bleeding post angioplasty.
Recent US showed high velocity jets and narrowing at anastomosis
to 3mm.
COMPARISON: Portal Vein Angioplasty 3/2014, US 5/6/14
PROCEDURE: An US examination was performed of the right and main
portal vein was performed and an access site for needle access
was identified. The patient was prepped and draped in sterile
fashion.
Using US guidance a 21g micropuncture needle was advanced in a
junction of right portal vein and main portal vein. An 0.018 inch
Nitrex wire was inserted through the needle and the wire
traversed the main portal vein stricture. A 4 French stiffened
micropuncture set was advanced over the main portal vein under
fluoroscopic
guidance. The micropuncture sheath was serially exchanged for a
6French vascular sheath.
A 4 Fr JB1 catheter was advanced over the wire into superior
mesenteric vein. Venography was performed. Pre and post stenotic
pressure were obtained. Based on the results of the pressure
gradient, image findings, and discussion the decision was made to
repeat the angioplasty of the stenosis. Angioplasty was performed
with a 6mm 2cm, 8mm 2cm Conquest balloons and a 10mm x 4cm
Mustang balloon. No significant waist was seen after each
insufflation to nominal balloon pressure. Post angioplasty
venogram was performed. Post angioplasty pressure measurements
and gradient were obtained.
The sheath was withdrawn and gelfoam tract embolization with
pledgets was performed via a 6F peel away sheath of the hepatic
access tract during removal. No post removal tract bleeding was
identified. There were no
complications and the patient left the IR suite in stable
condition. Dr. l was present for the entire procedure.
How am I to code for the SMV Venography?....
I also have 36481, 75885, 35476, 75978....
Can't find info on the SMV Venography....would it be 36011 or 36012 & ?...no more 75774, from what I've read?...
Exam: IR PTA Venous
IR Venogram Portal W/ Hemodynamics Completed: 05/08/2014 12:01 PM
05/08/2014 12:01 PM
Appt Loc: Main Interventional
Attending:
Indications:
Diagnosis:Status post liver transplantation [V42.7 (ICD-9-CM)]<br />Portal vein stenosis [459.2 (ICD-9-CM)]
Status post liver transplantation [V42.7 (ICD-9-CM)]<br />Portal vein stenosis [459.2 (ICD-9-CM)]
Reason:7 yo with hx of biliary atresia s/p liver transplant in 2007 with hx of portal vein stenosis, portal hypertension and esophageal varices/bleeding, s/p repeat angioplasty in IR
7 yo with hx of biliary atresia s/p liver transplant in 2007 with hx of portal vein stenosis, portal hypertension and esophageal varices/bleeding, s/p repeat angioplasty in IR
Interpretation:
PERCUTANEOUS PORTAL VEIN ANGIOPLASTY W PRESSURE MEASUREMENTS:
CLINICAL HISTORY: Gastric and esophageal varices, splenomegaly,
multiple variceal bleeds. s/p liver transplant. Prophylactic
portal vein angioplasty as patient has bled at interval of 1 yr
post prior angioplasty. To date no bleeding post angioplasty.
Recent US showed high velocity jets and narrowing at anastomosis
to 3mm.
COMPARISON: Portal Vein Angioplasty 3/2014, US 5/6/14
PROCEDURE: An US examination was performed of the right and main
portal vein was performed and an access site for needle access
was identified. The patient was prepped and draped in sterile
fashion.
Using US guidance a 21g micropuncture needle was advanced in a
junction of right portal vein and main portal vein. An 0.018 inch
Nitrex wire was inserted through the needle and the wire
traversed the main portal vein stricture. A 4 French stiffened
micropuncture set was advanced over the main portal vein under
fluoroscopic
guidance. The micropuncture sheath was serially exchanged for a
6French vascular sheath.
A 4 Fr JB1 catheter was advanced over the wire into superior
mesenteric vein. Venography was performed. Pre and post stenotic
pressure were obtained. Based on the results of the pressure
gradient, image findings, and discussion the decision was made to
repeat the angioplasty of the stenosis. Angioplasty was performed
with a 6mm 2cm, 8mm 2cm Conquest balloons and a 10mm x 4cm
Mustang balloon. No significant waist was seen after each
insufflation to nominal balloon pressure. Post angioplasty
venogram was performed. Post angioplasty pressure measurements
and gradient were obtained.
The sheath was withdrawn and gelfoam tract embolization with
pledgets was performed via a 6F peel away sheath of the hepatic
access tract during removal. No post removal tract bleeding was
identified. There were no
complications and the patient left the IR suite in stable
condition. Dr. l was present for the entire procedure.
