Shirleybala
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Hello all:
How to code this
I have coded as (37183, 36580)Is ths enough or i have to code it as stent placement vascular(37205)Please clarify.
Procedure:
TIPS REVISION
ANGIOPLASTY PERC VEIN
VASCATH/CVC NONTUNNELED FLUORO
VASCULAR STENT ADDITIONAL
HEPATIC VENO W/PRESS SI
The patient already had a right IJ triple lumen catheter in place.
The right neck and existing catheter were prepped and draped in
the usual sterile manner and locally anesthetized with 1%
lidocaine. IV Versed and fentanyl were administered for conscious
sedation and analgesia, patient was monitored by the
interventional radiology nurse.
The existing central line was exchanged over a Rosen wire and a
6-French 55-cm long bright tip sheath was placed. A 5-French
Cobra catheter and angled Glidewire were then used to selectively
catheterize the tips shunt. Contrast was injected and digital
subtraction angiography was performed in multiple oblique
projections.
. However, there is a weblike
stenosis in the hepatic vein above the tips
After measuring the size of the existing TIPS shunt, it was
elected to extend the shunt further into the hepatic vein with a
10-mm diameter by 6-cm long fluency covered stent. The fluency
was deployed extending approximately 1.5 cm further into the
hepatic vein. The stent was then post dilated to 10 mm.
Completion angiography was then performed, demonstrating improved
flow through the TIPS shunt. Additionally, the previously noted
opacification of the gastroesophageal varices was no longer
present.
Pressures were obtained, measured in the portal vein and in the
inferior vena cava. There is still an approximately 14-mm Hg
porto-systemic gradient at completion. However, the stent cannot
be extended further into the hepatic vein safely, and the TIPS
shunt itself is widely patent. It was unclear what could be done
in order to further reduce the gradient. Additionally,
angiographically the flow was much improved and the varices are no
longer filling. It was elected to stop at this time.
At completion the existing 9-French sheath that had been placed
was exchanged out for a triple lumen catheter, catheter tip
positioned at the cavoatrial junction. The catheter was sutured
in place, locked with heparin solution a sterile dressing applied.
The patient tolerated the procedure well, left the department in
stable condition.
How to code this
I have coded as (37183, 36580)Is ths enough or i have to code it as stent placement vascular(37205)Please clarify.
Procedure:
TIPS REVISION
ANGIOPLASTY PERC VEIN
VASCATH/CVC NONTUNNELED FLUORO
VASCULAR STENT ADDITIONAL
HEPATIC VENO W/PRESS SI
The patient already had a right IJ triple lumen catheter in place.
The right neck and existing catheter were prepped and draped in
the usual sterile manner and locally anesthetized with 1%
lidocaine. IV Versed and fentanyl were administered for conscious
sedation and analgesia, patient was monitored by the
interventional radiology nurse.
The existing central line was exchanged over a Rosen wire and a
6-French 55-cm long bright tip sheath was placed. A 5-French
Cobra catheter and angled Glidewire were then used to selectively
catheterize the tips shunt. Contrast was injected and digital
subtraction angiography was performed in multiple oblique
projections.
. However, there is a weblike
stenosis in the hepatic vein above the tips
After measuring the size of the existing TIPS shunt, it was
elected to extend the shunt further into the hepatic vein with a
10-mm diameter by 6-cm long fluency covered stent. The fluency
was deployed extending approximately 1.5 cm further into the
hepatic vein. The stent was then post dilated to 10 mm.
Completion angiography was then performed, demonstrating improved
flow through the TIPS shunt. Additionally, the previously noted
opacification of the gastroesophageal varices was no longer
present.
Pressures were obtained, measured in the portal vein and in the
inferior vena cava. There is still an approximately 14-mm Hg
porto-systemic gradient at completion. However, the stent cannot
be extended further into the hepatic vein safely, and the TIPS
shunt itself is widely patent. It was unclear what could be done
in order to further reduce the gradient. Additionally,
angiographically the flow was much improved and the varices are no
longer filling. It was elected to stop at this time.
At completion the existing 9-French sheath that had been placed
was exchanged out for a triple lumen catheter, catheter tip
positioned at the cavoatrial junction. The catheter was sutured
in place, locked with heparin solution a sterile dressing applied.
The patient tolerated the procedure well, left the department in
stable condition.