Unusual abscessogram with exchange

Liza559

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Need clarification of coding this procedure.
Would 99144/49424/76080; (2) 49423-59;(2)75984-59 be appropriate for this procedure?
Thank you - Liza


REPORT: CLINICAL HISTORY: Status post Whipple procedure. The patient has had an abscess which required exchange of the surgical drain for a modified biliary catheter placed in the left upper quadrant. He has an undrained collection in the right upper quadrant close by to the catheter. Previously, this was shown to fill with contrast material during injection of the surgical drain. He has episodes of sepsis during catheter flushing. Request is made to evaluate and revised catheters of possible.

PROCEDURE AND FINDINGS:
1. Contrast injection through existing catheter.
2. Catheter exchange and placement 2 new catheters.
3. Conscious sedation administered for 30 minutes.

Informed consent was obtained this procedure. The overall situation was discussed with the patient and his wife and the films were reviewed with his wife.

The skin was prepared and draped in conscious sedation was administered.

Initially, the existing catheter was aspirated showing about 5 to 7 cc of frank pus returning.

Exchange was made over 2 glide wires. 1 wire was left in place in the left upper quadrant and the other was used with a 5 French diagnostic catheter to enter the medially located cavity. An 8 French all-purpose drainage catheter was placed in this collection. A 10 French biliary drainage catheter was inserted into the left upper quadrant collection.

The smaller more medial collection was then injected showing brisk communication with the portal vein.

Both catheters were placed to suction drainage.

IMPRESSION: Able to drain the medial collection with a new 8 French all-purpose drainage catheter and reinserted slightly smaller biliary drainage catheter into the left upper quadrant all through the existing entry site.

The medially located catheter briskly communicates with the portal vein so it is possible there is an innoculation of blood stream during catheter flushing.

Findings were discussed with the patient and his wife.

Total 4.5 minutes intermittent fluoroscopy used.
 

dpeoples

True Blue
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Birmingham, Alabama
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Need clarification of coding this procedure.
Would 99144/49424/76080; (2) 49423-59;(2)75984-59 be appropriate for this procedure?
Thank you - Liza


REPORT: CLINICAL HISTORY: Status post Whipple procedure. The patient has had an abscess which required exchange of the surgical drain for a modified biliary catheter placed in the left upper quadrant. He has an undrained collection in the right upper quadrant close by to the catheter. Previously, this was shown to fill with contrast material during injection of the surgical drain. He has episodes of sepsis during catheter flushing. Request is made to evaluate and revised catheters of possible.

PROCEDURE AND FINDINGS:
1. Contrast injection through existing catheter.
2. Catheter exchange and placement 2 new catheters.
3. Conscious sedation administered for 30 minutes.

Informed consent was obtained this procedure. The overall situation was discussed with the patient and his wife and the films were reviewed with his wife.

The skin was prepared and draped in conscious sedation was administered.

Initially, the existing catheter was aspirated showing about 5 to 7 cc of frank pus returning.

Exchange was made over 2 glide wires. 1 wire was left in place in the left upper quadrant and the other was used with a 5 French diagnostic catheter to enter the medially located cavity. An 8 French all-purpose drainage catheter was placed in this collection. A 10 French biliary drainage catheter was inserted into the left upper quadrant collection.

The smaller more medial collection was then injected showing brisk communication with the portal vein.

Both catheters were placed to suction drainage.

IMPRESSION: Able to drain the medial collection with a new 8 French all-purpose drainage catheter and reinserted slightly smaller biliary drainage catheter into the left upper quadrant all through the existing entry site.

The medially located catheter briskly communicates with the portal vein so it is possible there is an innoculation of blood stream during catheter flushing.

Findings were discussed with the patient and his wife.

Total 4.5 minutes intermittent fluoroscopy used.
I don't see a contrast injection prior to the exchange, only an aspiration of the existing catheter. I would not code 49424/76080.
I do see an exchange and an apparently new drain/catheter placement.
I would code:
49423 for the exchange but not 75984 since no post exchange contrast injection is documented.
49021-59/75989 for the new drainage catheter.
99144 for Conscious Sedation

HTH
 

Liza559

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Thank you for assisting me with this, after I had sent this out I reviewed the images with the physicians and he did inject these catheters with contrast but saw that he did not dictate it, so has added an addendum to his report. Thank you again. :)
 
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