armygurl692@yahoo.com
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How should this be coded for the MD performing the procedure
Using real time ultrasound guidance a 21 guage micropuncture needle was used to access the right internal jugular vein. A .018 inch guidewire was advanced centrally under fluoroscopy. The need was removed and a micropuncture sheath system was placed. Under ultrasound guidance, documenation of vessel patency needle access with permanent recording, and reporting are performed followed by placement of a sheath in the right internal jugular vein.
A .035 inch guidewire was the advanced through the micorpuncture sheath and into the inferior vena cava. A long 9 french vascular sheath was exchanged over the guidewire and advanced into the IVC.
Using a catheter and guidewire technique under direct fluoroscopic guidance the right hepatic vein was then accessed with a direction catheter. A right hepatic venogram was performed with the injection of contrast which revealed normal course, caliber and contour of the right hepatic vein with appropriate hepafugal flow.
The transjugular liver biopsy system was advanced through the 9 french vascular sheath and multiple 18 gauge core liver biopsy specimens were obtained. These were then placed in formalin and submitted to pathology.
The directional catheter was then reintroduced and pressure measurements were then obtained in a pullback fashion. The 9 french vascular sheath were then removed from the right internal jugular vein and homeostasis was achieved with direct manual compression.
Total Fluroscopic time :7.1 minutes
Using real time ultrasound guidance a 21 guage micropuncture needle was used to access the right internal jugular vein. A .018 inch guidewire was advanced centrally under fluoroscopy. The need was removed and a micropuncture sheath system was placed. Under ultrasound guidance, documenation of vessel patency needle access with permanent recording, and reporting are performed followed by placement of a sheath in the right internal jugular vein.
A .035 inch guidewire was the advanced through the micorpuncture sheath and into the inferior vena cava. A long 9 french vascular sheath was exchanged over the guidewire and advanced into the IVC.
Using a catheter and guidewire technique under direct fluoroscopic guidance the right hepatic vein was then accessed with a direction catheter. A right hepatic venogram was performed with the injection of contrast which revealed normal course, caliber and contour of the right hepatic vein with appropriate hepafugal flow.
The transjugular liver biopsy system was advanced through the 9 french vascular sheath and multiple 18 gauge core liver biopsy specimens were obtained. These were then placed in formalin and submitted to pathology.
The directional catheter was then reintroduced and pressure measurements were then obtained in a pullback fashion. The 9 french vascular sheath were then removed from the right internal jugular vein and homeostasis was achieved with direct manual compression.
Total Fluroscopic time :7.1 minutes