Question tPA admin via EVD catheter

tboback

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Hello, My neurosurgeon is doing this and the codes I come up with are: 61120, 61781, and 61645.
Can anyone tell me if I'm correct or maybe direct me to the correct codes?
Second question would be if tPA is administered on a subsequent days, how do I code them?

OP Note:
Postoperative diagnosis: 1.) hypertensive basal ganglia hemorrhage with right to left midline shift, left hemiplegia

Procedure: 1.) right external drain placement, stereotactic placement of catheter Indications:

The patient is an xx yo complete a CT head which revealed a hypertensive basal ganglia hemorrhage on the right side. Given this finding, I did review with the patient's family the risks and benefits of both surgical versus nonsurgical options. After we discussed multiple options including craniotomy, evacuation of clot, versus stereotactic placement of drain and injection of tPA, they elected to proceed with this. They did understand that this is an experimental procedure. All their questions answered to their satisfaction. Patient was brought to the operative suite. Was already intubated from the emergency department. She was placed under general anesthesia. She was placed in a supine position with all pressure points being padded appropriately. At this point, the stereotactic navigation system, Stealth Axiom system, was then attached. I did register the head an approximate incision site. Her hair was clipped, she was then prepped and draped in the usual sterile fashion. A time-out was completed, antibiotics were administered, and the skin was infiltrated with Marcaine with epinephrine after the patient had been prepped and draped in the usual sterile fashion. The skin was infiltrated with Marcaine with epinephrine, I did make a skin incision with a #10 blade. Electrocautery Bovie was utilized to obtain hemostasis. A self-retaining retractor was placed within the incision site. I then trephinated the skull utilizing a perforator. The dura was coagulated with bipolar irrigation. Then, this was cut in a cruciate fashion with a #11 blade. At this point, I utilized a stereotactic needle to advance the catheter into the clot. Once this was advanced, I did notice a little bit of blood return. At this point, I did inject a little tPA, timed it for 1 hour. I did basket weaved the drain into position. The incision was closed with 2-0 Vicryl suture and staples. All counts were correct. The patient tolerated the procedure well and a CT head was obtained postoperatively.
 
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