transjugular liver biopsy


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The right lower neck was prepped and draped in the usual sterile
fashion. After the administration of local anesthesia and under
ultrasound guidance, access into the right internal jugular vein
was obtained with a 21-gauge micropuncture set. A Bentson wire
was advanced through the transition dilator and into the IVC. The
transition dilator was exchanged for a 8-French vascular sheath.
A 5-French multi-purpose catheter was then advanced over the wire
and a catheter and wire were used to select the middle hepatic
vein. A gentle injection of contrast was then performed and
multiple spot images were obtained in multiple obliquities. This
confirmed good positioning of the catheter within the middle
hepatic vein.

The catheter was removed over a stiff guidewire which was advanced
into the peripheral middle hepatic vein. A 14-F cyst rench Cook
transjugular liver biopsy sheath was then advanced over the wire
and coaxially through the 8-French sheath and into the middle
hepatic vein. The wire was removed and the Cook 19 gauge
automated spring-loaded transjugular core biopsy needle was then
advanced coaxially through the sheath, obtained anteriorly and a
19-gauge core biopsy of the liver was obtained. This was repeated
several times and a total of four specimens were obtained.

What should be the codes for the above procedure??