Transjuglar liver biopsy

she803

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Physician coded this report as 99144, 36011, 37200, 75970-26; 75889-59-26; and 76937-26 but cpt 76937 is add on code. Does the inital cpt code 76936 applies to this report? Thanks!

History:

This is 58 year-old male with history of hepatitis referred for transjugular lliver biopsy.

Procedure:

Following informed consent the patient was placed in the supine position and continuous physiologic monitoring was performed throughout the procedure. The patient received conscious sedation using intravenous Versed and fentanyl. The patient was fully recovered in interventional holding area under direct continues monitoring.

Following sterile prep and drape of the right the lower neck, the 21 gauge needle was advanced into the right jugular vein. 9F sheath was placed. The inferior vena cava was accessed. The multi-purpose angle catheter was used to access the right hepatic vein. The catheter was advanced into the wedged position. Wedged and free hepatic vein pressures were obtained. In addition an IVC and RA pressures were obtained.

Via a 7 French sheath transjugular liver biopsy was obtained using an 19 gauge automated biopsy system. A total of 4 core biopsies were obtained. There were no immediate complications.

Findings:

Wedged and free hepatic venograms demonstrate normal venous anatomy. The wedged hepatic vein pressure is 18mm Hg . Free hepatic vein pressure is15 mm Hg. The mean RA pressure is 13 mm Hg. Infrahepatic IVC pressure is 14 mm Hg. Those pressures are normal..

Impression:

Transjugular liver biopsy as described above.
 

donnajrichmond

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Physician coded this report as 99144, 36011, 37200, 75970-26; 75889-59-26; and 76937-26 but cpt 76937 is add on code. Does the inital cpt code 76936 applies to this report? Thanks!

History:

This is 58 year-old male with history of hepatitis referred for transjugular lliver biopsy.

Procedure:

Following informed consent the patient was placed in the supine position and continuous physiologic monitoring was performed throughout the procedure. The patient received conscious sedation using intravenous Versed and fentanyl. The patient was fully recovered in interventional holding area under direct continues monitoring.

Following sterile prep and drape of the right the lower neck, the 21 gauge needle was advanced into the right jugular vein. 9F sheath was placed. The inferior vena cava was accessed. The multi-purpose angle catheter was used to access the right hepatic vein. The catheter was advanced into the wedged position. Wedged and free hepatic vein pressures were obtained. In addition an IVC and RA pressures were obtained.

Via a 7 French sheath transjugular liver biopsy was obtained using an 19 gauge automated biopsy system. A total of 4 core biopsies were obtained. There were no immediate complications.

Findings:

Wedged and free hepatic venograms demonstrate normal venous anatomy. The wedged hepatic vein pressure is 18mm Hg . Free hepatic vein pressure is15 mm Hg. The mean RA pressure is 13 mm Hg. Infrahepatic IVC pressure is 14 mm Hg. Those pressures are normal..

Impression:

Transjugular liver biopsy as described above.
76937 - US guidance for vascular access - can be coded with any procedures where ultrasound is required for vascular access unless specifically excluded by coding guidelines. However, if the doctor wants to code 76937, he's going to have to document it. I don't see ultrasound mentioned at all, and this code requires very specific documentation as specified in the code description.
I also have a problem with 99144 and 75889. Moderate sedation 99144 is a timed code. He doesn't have any time documented (he needs at least 16 minutes of physician face-to-face time). And as documented, 75889 looks more like roadmapping than a diagnostic study.
 
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