iamlou
Networker
Can someone please help me with codes for this? I have:
36005/75820 for the venogram,
37187 for the aspiration thrombectomy, and
35476/75978 for the balloon angioplasty.
I also have 36584 for the PICC replacement.
Am I close? Thanks for all suggestions!
PRE-PROCEDURE DIAGNOSIS:
Right axillosubclavian vein thrombosis, sepsis
PROCEDURES PERFORMED:
RIGHT UPPER EXTREMITY CENTRAL VENOGRAM, RIGHT AXILLOSUBCLAVIAN VEIN
CATHETER DIRECTED THROMBOLYSIS, BALLOON ANGIOPLASTY, ASPIRATION
THROMBECTOMY, RIGHT INNOMINATE VEIN BALLOON ANGIOPLASTY, RIGHT CEPHALIC
VEIN SINGLE LUMEN PICC LINE EXCHANGED FOR DOUBLE-LUMEN PICC LINE.
IMAGING MODALITY UTILIZED:
Ultrasound and fluoroscopy
ANESTHESIA: Local.
ACCESS SITE:
Right basilic vein
CATHETER POSITION:
Right axillary vein, subclavian vein, SVC
TECHNIQUE: Skin overlying the right upper extremity inclusive of the right cephalic vein PICC line was sterilely prepped and draped in standard fashion.
Preprocedure antibiotics were administered. Under ultrasound guidance, the
above elbow basilic vein was accessed. A 7 French sheath was inserted.
Limited central venogram was performed, which demonstrates filling defects
and subtotal occlusive thrombosis of the right axillosubclavian vein.
There is a right innominate vein stenosis. There is a right cephalic vein
single-lumen PICC line with tip overlying the distal SVC.
The 7 French sheath was advanced into the axillosubclavian vein thrombus
over a 0.035 inch Bentson guidewire. Aspiration thrombectomy was conducted
initially. Heparin was administered. Thrombus was recovered and submitted
for culture analysis. Subsequently, a 5 French/10 cm infusion length
catheter was positioned within the axial subclavian thrombosed segment. A
total of 8 mg of TPA were administered using pulse spray technique. 8
milligrams were administered using split dose (4 mg x 2). Subsequently,
the axillosubclavian vein was further treated with balloon maceration using
an 8 mm balloon. The right innominate vein was treated with balloon
angioplasty to facilitate outflow using 8mm and 10 mm balloons. The
axillosubclavian vein segment was further treated with aspiration
thrombectomy, and balloon maceration using a larger size 10 mm balloon.
The right upper extremity cephalic vein PICC line was subsequently
exchanged over a 0.018 inch angled gold-tip Glidewire for a new 5 French
double-lumen PICC line. The cut length is 51 cm, the external length is 1
cm. The PICC line was secured to the skin and sterile dressing was
applied. The basilic vein access site was removed and compression
applied.
FINDINGS:
Limited right upper extremity central venogram demonstrates thrombotic
occlusion of the right axillosubclavian vein. High-grade right innominate
vein stenosis. SVC patent. Peripheral venous system not evaluated in
attempt to minimize contrast load in this patient with compromised renal
function. As described above, the axillosubclavian vein thrombus was
sampled for cultures, and treated with single stage thrombolysis, balloon
angioplasty, and aspiration thrombectomy. Completion study demonstrates
restored patency through the axillosubclavian vein with an element of
residual, possibly chronic wall-adherent thrombus. Given the presence of
infection, and lack of significant right upper extremity arm swelling.
Further adjunct methods such as stent placement were not performed.
As described above, the right cephalic vein PICC line was exchanged and
upsized for a 5 French double-lumen PICC line. Tip was positioned in the
distal SVC.
THERE IS A HIGH-GRADE RIGHT
INNOMINATE VEIN STENOSIS. AS DESCRIBED IN DETAIL ABOVE, AXILLOSUBCLAVIAN
VEIN THROMBOSIS WAS SAMPLED FOR CULTURE GIVEN THE CONCERN FOR SEPSIS.
SUBSEQUENT ATTEMPTS AT RESTORATION OF VEIN PATENCY WERE PERFORMED USING
CATHETER DIRECTED THROMBOLYSIS, BALLOON MACERATION ANGIOPLASTY AND
ASPIRATION THROMBECTOMY. THERE IS RESTORATION OF PROGRADE FLOW, HOWEVER
THERE IS RESIDUAL THROMBUS WITHIN THE AXILLOSUBCLAVIAN VEIN, THIS COULD
REFLECT CHRONIC WALL ADHERENT THROMBUS. GIVEN THE PRESENCE OF SEPSIS, AND
LACK OF SIGNIFICANT RIGHT UPPER EXTREMITY ARM SWELLING, FURTHER ADJUVANT
METHODS SUCH AS STENT INSERTION WERE NOT PERFORMED.
RIGHT UPPER EXTREMITY PICC LINE EXCHANGED AND UPSIZED FOR A 5 FRENCH
DOUBLE-LUMEN PICC LINE AS DESCRIBED.
36005/75820 for the venogram,
37187 for the aspiration thrombectomy, and
35476/75978 for the balloon angioplasty.
I also have 36584 for the PICC replacement.
Am I close? Thanks for all suggestions!
PRE-PROCEDURE DIAGNOSIS:
Right axillosubclavian vein thrombosis, sepsis
PROCEDURES PERFORMED:
RIGHT UPPER EXTREMITY CENTRAL VENOGRAM, RIGHT AXILLOSUBCLAVIAN VEIN
CATHETER DIRECTED THROMBOLYSIS, BALLOON ANGIOPLASTY, ASPIRATION
THROMBECTOMY, RIGHT INNOMINATE VEIN BALLOON ANGIOPLASTY, RIGHT CEPHALIC
VEIN SINGLE LUMEN PICC LINE EXCHANGED FOR DOUBLE-LUMEN PICC LINE.
IMAGING MODALITY UTILIZED:
Ultrasound and fluoroscopy
ANESTHESIA: Local.
ACCESS SITE:
Right basilic vein
CATHETER POSITION:
Right axillary vein, subclavian vein, SVC
TECHNIQUE: Skin overlying the right upper extremity inclusive of the right cephalic vein PICC line was sterilely prepped and draped in standard fashion.
Preprocedure antibiotics were administered. Under ultrasound guidance, the
above elbow basilic vein was accessed. A 7 French sheath was inserted.
Limited central venogram was performed, which demonstrates filling defects
and subtotal occlusive thrombosis of the right axillosubclavian vein.
There is a right innominate vein stenosis. There is a right cephalic vein
single-lumen PICC line with tip overlying the distal SVC.
The 7 French sheath was advanced into the axillosubclavian vein thrombus
over a 0.035 inch Bentson guidewire. Aspiration thrombectomy was conducted
initially. Heparin was administered. Thrombus was recovered and submitted
for culture analysis. Subsequently, a 5 French/10 cm infusion length
catheter was positioned within the axial subclavian thrombosed segment. A
total of 8 mg of TPA were administered using pulse spray technique. 8
milligrams were administered using split dose (4 mg x 2). Subsequently,
the axillosubclavian vein was further treated with balloon maceration using
an 8 mm balloon. The right innominate vein was treated with balloon
angioplasty to facilitate outflow using 8mm and 10 mm balloons. The
axillosubclavian vein segment was further treated with aspiration
thrombectomy, and balloon maceration using a larger size 10 mm balloon.
The right upper extremity cephalic vein PICC line was subsequently
exchanged over a 0.018 inch angled gold-tip Glidewire for a new 5 French
double-lumen PICC line. The cut length is 51 cm, the external length is 1
cm. The PICC line was secured to the skin and sterile dressing was
applied. The basilic vein access site was removed and compression
applied.
FINDINGS:
Limited right upper extremity central venogram demonstrates thrombotic
occlusion of the right axillosubclavian vein. High-grade right innominate
vein stenosis. SVC patent. Peripheral venous system not evaluated in
attempt to minimize contrast load in this patient with compromised renal
function. As described above, the axillosubclavian vein thrombus was
sampled for cultures, and treated with single stage thrombolysis, balloon
angioplasty, and aspiration thrombectomy. Completion study demonstrates
restored patency through the axillosubclavian vein with an element of
residual, possibly chronic wall-adherent thrombus. Given the presence of
infection, and lack of significant right upper extremity arm swelling.
Further adjunct methods such as stent placement were not performed.
As described above, the right cephalic vein PICC line was exchanged and
upsized for a 5 French double-lumen PICC line. Tip was positioned in the
distal SVC.
THERE IS A HIGH-GRADE RIGHT
INNOMINATE VEIN STENOSIS. AS DESCRIBED IN DETAIL ABOVE, AXILLOSUBCLAVIAN
VEIN THROMBOSIS WAS SAMPLED FOR CULTURE GIVEN THE CONCERN FOR SEPSIS.
SUBSEQUENT ATTEMPTS AT RESTORATION OF VEIN PATENCY WERE PERFORMED USING
CATHETER DIRECTED THROMBOLYSIS, BALLOON MACERATION ANGIOPLASTY AND
ASPIRATION THROMBECTOMY. THERE IS RESTORATION OF PROGRADE FLOW, HOWEVER
THERE IS RESIDUAL THROMBUS WITHIN THE AXILLOSUBCLAVIAN VEIN, THIS COULD
REFLECT CHRONIC WALL ADHERENT THROMBUS. GIVEN THE PRESENCE OF SEPSIS, AND
LACK OF SIGNIFICANT RIGHT UPPER EXTREMITY ARM SWELLING, FURTHER ADJUVANT
METHODS SUCH AS STENT INSERTION WERE NOT PERFORMED.
RIGHT UPPER EXTREMITY PICC LINE EXCHANGED AND UPSIZED FOR A 5 FRENCH
DOUBLE-LUMEN PICC LINE AS DESCRIBED.