suela923@aol.com
Guest
- Messages
- 178
- Best answers
- 0
We are billing: 36561, 77001, 76937, 35476,75978, 36010, plus 75827,75860.
I feel that the SVC and IJ Gram are part of 77001 as related venography. Any input is appreciated!! Thanks, Sue
IR MEDIPORT INSERTION
Exam Date: 05/23/2014
Exam Time: 12:40 PM
Addendum:
There are no other prior catheter based venograms with which to compare. Decision to intervene on today's study was based on today's diagnostic exam.
Mediport insertion with venogram and angioplasty as described above.
Ultrasound and fluoroscopic guided left chest port placement; left internal jugular vein venogram, SVC gram, SVC and left brachiocephalic vein angioplasty
History:Metastatic sarcoma. For port placement. Right-sided implantable AICD-pacemaker.
Technique: Timeout was performed. Maximal sterile barrier technique was utilized. Skin over the left neck and chest was prepped and draped sterilely. 2% lidocaine and 2% lidocaine with epinephrine were used as local anesthetic. Moderate sedation was also administered. Ultrasound was used to determine potential access sites and for real-time guidance into the left internal jugular vein. Images were recorded and made part of the patient's permanent medical record. 18-gauge single wall needle was advanced into the left internal jugular vein and a wire was advanced under fluoroscopic guidance to the right atrium. Peel-away sheath could not be advanced centrally. Left internal jugular vein venogram was performed. Catheter was advanced to the SVC and SVC gram was performed. Over an Amplatz stiff wire, a 6 mm x 80 mm angioplasty was performed across the left brachiocephalic vein and SVC. A 9-French peel-away sheath was advanced into the right atrium. Additional lidocaine was instilled. Transverse incision was made over the anterior left second rib laterally. Subcutaneous pocket was created using blunt dissection the pocket was irrigated. From this site, to the IJ puncture site, a tunneled track was created and the catheter was advanced through the tract. Catheter was connected to the 8-French VUE port and the port was checked for leaks. Catheter was cut to the appropriate length and advanced through a peel-away sheath to the right atrium at the cavoatrial junction. Peel-away sheath was removed. X-ray of the chest was obtained to document catheter position. The port pocket was closed using 2-0 Vicryl interrupted sutures and 4-0 Vicryl subcuticular stitch. Dermatotomy site was closed using 4-0 Vicryl. Steri-Strips were applied. The port was flushed with 500 units of heparin. Patient tolerated the procedure well with no complications.
Findings: The left internal jugular vein is widely patent and normally compressible. Needle seen coursing into the vein. The venogram shows a persistent left superior vena cava. Left internal jugular vein patent. There is a small left brachiocephalic vein. The left brachiocephalic vein was traversed as was the SVC. SVC gram shows a narrowed SVC with AICD-pacemaker wires in place. Six millimeter angioplasty was performed across the SVC and left brachiocephalic vein. The 9-French sheath could then be advanced centrally to right atrium. 8-French Mediport VUE PowerPort, 29 cm catheter length, was placed in excellent position the tip at the cavoatrial junction. Peel-away sheath was removed. Ports flush easily with good blood return.
IMPRESSION:
Persistent left SVC with small left brachiocephalic vein. Angioplasty of left brachiocephalic vein and SVC stenosis.
Successful and uncomplicated left chest port placement.
I feel that the SVC and IJ Gram are part of 77001 as related venography. Any input is appreciated!! Thanks, Sue
IR MEDIPORT INSERTION
Exam Date: 05/23/2014
Exam Time: 12:40 PM
Addendum:
There are no other prior catheter based venograms with which to compare. Decision to intervene on today's study was based on today's diagnostic exam.
Mediport insertion with venogram and angioplasty as described above.
Ultrasound and fluoroscopic guided left chest port placement; left internal jugular vein venogram, SVC gram, SVC and left brachiocephalic vein angioplasty
History:Metastatic sarcoma. For port placement. Right-sided implantable AICD-pacemaker.
Technique: Timeout was performed. Maximal sterile barrier technique was utilized. Skin over the left neck and chest was prepped and draped sterilely. 2% lidocaine and 2% lidocaine with epinephrine were used as local anesthetic. Moderate sedation was also administered. Ultrasound was used to determine potential access sites and for real-time guidance into the left internal jugular vein. Images were recorded and made part of the patient's permanent medical record. 18-gauge single wall needle was advanced into the left internal jugular vein and a wire was advanced under fluoroscopic guidance to the right atrium. Peel-away sheath could not be advanced centrally. Left internal jugular vein venogram was performed. Catheter was advanced to the SVC and SVC gram was performed. Over an Amplatz stiff wire, a 6 mm x 80 mm angioplasty was performed across the left brachiocephalic vein and SVC. A 9-French peel-away sheath was advanced into the right atrium. Additional lidocaine was instilled. Transverse incision was made over the anterior left second rib laterally. Subcutaneous pocket was created using blunt dissection the pocket was irrigated. From this site, to the IJ puncture site, a tunneled track was created and the catheter was advanced through the tract. Catheter was connected to the 8-French VUE port and the port was checked for leaks. Catheter was cut to the appropriate length and advanced through a peel-away sheath to the right atrium at the cavoatrial junction. Peel-away sheath was removed. X-ray of the chest was obtained to document catheter position. The port pocket was closed using 2-0 Vicryl interrupted sutures and 4-0 Vicryl subcuticular stitch. Dermatotomy site was closed using 4-0 Vicryl. Steri-Strips were applied. The port was flushed with 500 units of heparin. Patient tolerated the procedure well with no complications.
Findings: The left internal jugular vein is widely patent and normally compressible. Needle seen coursing into the vein. The venogram shows a persistent left superior vena cava. Left internal jugular vein patent. There is a small left brachiocephalic vein. The left brachiocephalic vein was traversed as was the SVC. SVC gram shows a narrowed SVC with AICD-pacemaker wires in place. Six millimeter angioplasty was performed across the SVC and left brachiocephalic vein. The 9-French sheath could then be advanced centrally to right atrium. 8-French Mediport VUE PowerPort, 29 cm catheter length, was placed in excellent position the tip at the cavoatrial junction. Peel-away sheath was removed. Ports flush easily with good blood return.
IMPRESSION:
Persistent left SVC with small left brachiocephalic vein. Angioplasty of left brachiocephalic vein and SVC stenosis.
Successful and uncomplicated left chest port placement.