My codes for the below procedure are
36558
36589
36005-5950
75822-26
76937-26.
Do we need to code SVC gram(75827-26) for the below procedure???
Procedure in brief: Bilateral upper extremity venogram, removal of
right internal jugular permacatheter, left external jugular
permacath placement
Angiocaths were placed into arm veins bilaterally. Bilateral upper
extremity venography was then performed. With the patient in the
supine position the left upper chest region was prepped and draped
in the usual sterile fashion. Ultrasound examination demonstrates
occlusion of the left internal jugular vein. The left external
jugular vein is patent. The external jugular vein was then
accessed via posterior approach under real-time ultrasound
guidance using a 21-gauge micropuncture needle. A 4 French tapered
dilator was placed via this puncture site. A stiff guidewire was
then placed extending into the right atrium. The tract was
sequentially dilated up to 15 French and a peel-away sheath
placed.
A site along the more inferolateral aspect of the chest was
selected and the overlying skin was anesthetized with 1% Xylocaine
solution. A small transverse incision was made a tract created
from the incision to the venotomy site using a tunneling device. A
14 French, 27 cm long Split cath permacath was then advanced along
this tract, placed through the peel-away sheath and massaged into
position. The peel-away sheath was then removed. The catheter was
sutured into place using 2-0 Ethilon sutures. Each catheter port
was aspirated and primed with heparin. A sterile dressing was then
applied.
The right upper chest region and catheter were then prepped and
draped in usual sterile fashion. After the administration of local
anesthesia, the subcutaneous cuff was freed using blunt
dissection. The indwelling catheter was then withdrawn into the
right brachiocephalic vein. A superior venacavogram was performed
demonstrating narrowing within the brachiocephalic vein with an
extensive fibrin sheath. The catheter was then removed.
Compression was applied to the venotomy and skin entry sites until
adequate hemostasis was achieved. The site was covered with a
sterile dressing. The patient tolerated the procedure without
incident.
Findings: Bilateral upper extremity venography demonstrating
patency of the left cephalic and basilic veins within the upper
arm. The left axillary, subclavian and brachiocephalic veins are
patent. The superior vena cava is patent. The right basilic and
brachial veins in the upper arm are patent. The axillary and
subclavian veins are occluded. Collateral vessels are identified
in the supraclavicular region. The brachiocephalic vein is not
opacified. These findings are consistent with acute or subacute
thrombus within the axillary vein.
Superior venacavogram demonstrating extensive fibrin sheath versus
severe narrowing within the right brachiocephalic vein along the
course of the catheter.
Following left external jugular PermCath placement, distal
catheter tip is identified overlying the proximal right atrium in
good position.
Impression:
Right upper extremity venogram demonstrating axillo-subclavian
venous occlusion suspicious for acute versus subacute thrombosis.
Severe narrowing within the brachiocephalic vein is identified.
The superior vena cava is patent. The left axillary, subclavian
and brachiocephalic veins are patent.
Successful placement of 27 cm, double lumen left external jugular
permacath with its distal tip extending to the proximal right
atrium as described above.
Successful removal of right internal jugular permacath.
36558
36589
36005-5950
75822-26
76937-26.
Do we need to code SVC gram(75827-26) for the below procedure???
Procedure in brief: Bilateral upper extremity venogram, removal of
right internal jugular permacatheter, left external jugular
permacath placement
Angiocaths were placed into arm veins bilaterally. Bilateral upper
extremity venography was then performed. With the patient in the
supine position the left upper chest region was prepped and draped
in the usual sterile fashion. Ultrasound examination demonstrates
occlusion of the left internal jugular vein. The left external
jugular vein is patent. The external jugular vein was then
accessed via posterior approach under real-time ultrasound
guidance using a 21-gauge micropuncture needle. A 4 French tapered
dilator was placed via this puncture site. A stiff guidewire was
then placed extending into the right atrium. The tract was
sequentially dilated up to 15 French and a peel-away sheath
placed.
A site along the more inferolateral aspect of the chest was
selected and the overlying skin was anesthetized with 1% Xylocaine
solution. A small transverse incision was made a tract created
from the incision to the venotomy site using a tunneling device. A
14 French, 27 cm long Split cath permacath was then advanced along
this tract, placed through the peel-away sheath and massaged into
position. The peel-away sheath was then removed. The catheter was
sutured into place using 2-0 Ethilon sutures. Each catheter port
was aspirated and primed with heparin. A sterile dressing was then
applied.
The right upper chest region and catheter were then prepped and
draped in usual sterile fashion. After the administration of local
anesthesia, the subcutaneous cuff was freed using blunt
dissection. The indwelling catheter was then withdrawn into the
right brachiocephalic vein. A superior venacavogram was performed
demonstrating narrowing within the brachiocephalic vein with an
extensive fibrin sheath. The catheter was then removed.
Compression was applied to the venotomy and skin entry sites until
adequate hemostasis was achieved. The site was covered with a
sterile dressing. The patient tolerated the procedure without
incident.
Findings: Bilateral upper extremity venography demonstrating
patency of the left cephalic and basilic veins within the upper
arm. The left axillary, subclavian and brachiocephalic veins are
patent. The superior vena cava is patent. The right basilic and
brachial veins in the upper arm are patent. The axillary and
subclavian veins are occluded. Collateral vessels are identified
in the supraclavicular region. The brachiocephalic vein is not
opacified. These findings are consistent with acute or subacute
thrombus within the axillary vein.
Superior venacavogram demonstrating extensive fibrin sheath versus
severe narrowing within the right brachiocephalic vein along the
course of the catheter.
Following left external jugular PermCath placement, distal
catheter tip is identified overlying the proximal right atrium in
good position.
Impression:
Right upper extremity venogram demonstrating axillo-subclavian
venous occlusion suspicious for acute versus subacute thrombosis.
Severe narrowing within the brachiocephalic vein is identified.
The superior vena cava is patent. The left axillary, subclavian
and brachiocephalic veins are patent.
Successful placement of 27 cm, double lumen left external jugular
permacath with its distal tip extending to the proximal right
atrium as described above.
Successful removal of right internal jugular permacath.