Shirleybala
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Hi,
How to code US AND FLUORO guidance for this procedure,Is the procedure code 49420 please confirm.
Procedure: Ultrasound and fluoroscopically guided placement of a
tunneled peritoneal paracentesis catheter (Tenckhoff catheter).
Clinical history:
53-year-old male with advanced, endstage liver cirrhosis and
intractable large volume ascites, requiring frequent large volume
paracentesis. Referred for placement of a tunneled Tenckhoff type
catheter, so that patient can drain his ascites at home as
necessary.
Procedure:
Initially the procedure was discussed at length with the patient
including risks benefits and alternatives. Risks discussed
included but were not limited to bleeding, infection,
intra-abdominal organ and bowel injury, peritonitis etc.. The
patient appeared to understand, asked appropriate questions and
signed informed consent. Procedure duration was one hour.
Intravenous versed and Fentanyl were administered for conscious
sedation and analgesia, monitored by the interventional radiology
nurse. 1.0 minutes fluoroscopy time.
The patient received IV antibiotics prior to the procedure.
Preliminary ultrasound was performed over the right lower quadrant
and infraumbilical region, and a suitable large pocket of fluid
was marked over the right infraumbilical region. An exit site was
also marked, approximately 7 cm from the marked puncture site.
The patient's abdomen was then double prepped and draped in the
usual sterile manner and locally anesthetized with lidocaine with
epinephrine. A 17 gauge guiding needle was used, advanced from
the catheter exit site to the region of the puncture site. A
curved 20 gauge Chiba needle was then advanced through the lumen
of the guiding needle, after a curved had been placed on the tip.
Using external compression the needle was then advanced out the
tip of the guiding catheter, and used to access the peritoneal
cavity. Confirmation of needle positioning was confirmed with
sonography, and a permanent sonographic recording was created for
the patient's medical record. A Cope guide wire was advanced into
the peritoneal cavity, documented looping in the abdomen.
The entire tract was then dilated with an Inter-V triaxial
introducer set and an adjacent Amplatz wire was placed. The 4F
inner catheter was readvanced of the Cope guide wire, and
lidocaine without epinephrine was then injected, as the catheter
was withdrawn through the entire tract. Sequential dilatation was
then performed over the Amplatz wire, the puncture was dilated to
18 French, and the tunnel was dilated to 20 French. Via an 18
French peel-away sheath, the Tenckhoff catheter was advanced until
the subcutaneous cuff resides in the middle of the tunnel. The
peelaway sheath was removed, there was a rush of fluid from the
catheter. A purse string suture was then placed at the catheter
exit site in order to maintain catheter position as well as to
prevent leakage of ascites. The patient's ascites was then
drained, yielding approximately 8 L of clear, straw-colored fluid
and sterile dressing applied. The patient tolerated the procedure
well, left the department in stable condition.
Impression:
15 French Tenckhoff tunneled peritoneal paracentesis catheter
placed using single stick technique. No immediate complications.
Patient given instructions on using catheter to drain ascites at
home. Patient also given follow-up appointment for removal of the
skin sutures.
How to code US AND FLUORO guidance for this procedure,Is the procedure code 49420 please confirm.
Procedure: Ultrasound and fluoroscopically guided placement of a
tunneled peritoneal paracentesis catheter (Tenckhoff catheter).
Clinical history:
53-year-old male with advanced, endstage liver cirrhosis and
intractable large volume ascites, requiring frequent large volume
paracentesis. Referred for placement of a tunneled Tenckhoff type
catheter, so that patient can drain his ascites at home as
necessary.
Procedure:
Initially the procedure was discussed at length with the patient
including risks benefits and alternatives. Risks discussed
included but were not limited to bleeding, infection,
intra-abdominal organ and bowel injury, peritonitis etc.. The
patient appeared to understand, asked appropriate questions and
signed informed consent. Procedure duration was one hour.
Intravenous versed and Fentanyl were administered for conscious
sedation and analgesia, monitored by the interventional radiology
nurse. 1.0 minutes fluoroscopy time.
The patient received IV antibiotics prior to the procedure.
Preliminary ultrasound was performed over the right lower quadrant
and infraumbilical region, and a suitable large pocket of fluid
was marked over the right infraumbilical region. An exit site was
also marked, approximately 7 cm from the marked puncture site.
The patient's abdomen was then double prepped and draped in the
usual sterile manner and locally anesthetized with lidocaine with
epinephrine. A 17 gauge guiding needle was used, advanced from
the catheter exit site to the region of the puncture site. A
curved 20 gauge Chiba needle was then advanced through the lumen
of the guiding needle, after a curved had been placed on the tip.
Using external compression the needle was then advanced out the
tip of the guiding catheter, and used to access the peritoneal
cavity. Confirmation of needle positioning was confirmed with
sonography, and a permanent sonographic recording was created for
the patient's medical record. A Cope guide wire was advanced into
the peritoneal cavity, documented looping in the abdomen.
The entire tract was then dilated with an Inter-V triaxial
introducer set and an adjacent Amplatz wire was placed. The 4F
inner catheter was readvanced of the Cope guide wire, and
lidocaine without epinephrine was then injected, as the catheter
was withdrawn through the entire tract. Sequential dilatation was
then performed over the Amplatz wire, the puncture was dilated to
18 French, and the tunnel was dilated to 20 French. Via an 18
French peel-away sheath, the Tenckhoff catheter was advanced until
the subcutaneous cuff resides in the middle of the tunnel. The
peelaway sheath was removed, there was a rush of fluid from the
catheter. A purse string suture was then placed at the catheter
exit site in order to maintain catheter position as well as to
prevent leakage of ascites. The patient's ascites was then
drained, yielding approximately 8 L of clear, straw-colored fluid
and sterile dressing applied. The patient tolerated the procedure
well, left the department in stable condition.
Impression:
15 French Tenckhoff tunneled peritoneal paracentesis catheter
placed using single stick technique. No immediate complications.
Patient given instructions on using catheter to drain ascites at
home. Patient also given follow-up appointment for removal of the
skin sutures.
