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Hi, please check below procedure note, I need the CPT code, or what you think this procedure note sufficient for varithena injection??
Your answer or response would be appreciated.
Procedure Performed: Ultrasound-guided microfoam chemical ablation with Varithena of the right GSV from below the SFJ to mid-calf access secondary to GSV incompetence.
Anesthesia: Local 1% lidocaine cutaneous anesthetic.
Indications for Procedure: Please refer to clinical notes. Patient has had continuation of symptoms despite 3 months of conservative medical therapy. The patient underwent informed consent including management options where the complications of infection, bleeding, pain, and skin injury were discussed. Particular attention was spent discussing thrombus extension and deep vein thrombosis.
Procedure: The patient walked to the procedure room. Procedure began at 10:40 am. All applicable staff donned appropriate apparel. A procedure timeout was performed to confirm correct patient, correct extremity, correct procedure, and correct room set-up including presence of all applicable supplies, devices, and drugs.
Monitoring devices were appropriately positioned. A duplex ultrasound scan, performed by a registered vascular technologist confirmed the location and incompetence of the GSV and its course marked on the skin together with the dilated tributaries. The extent of treatment of the GSV and the associated varicosities was determined through ultrasound mapping by the treating physician.
The patient was placed on the operating room table and was evaluated in reverse Trendelenburg position. The limb was prepped and sterile drapes were applied. A skin wheal was made to facilitate access using 1.0% lidocaine at the chosen puncture site in the lower thigh overlying the GSV. The skin was punctured through the anesthetized skin with the venous access needle and advanced under ultrasound guidance. Access was established to the target vessel and venous access confirmed by aspiration of dark low pressure blood. Upon gaining all access sites both above and below the knee, the target limb was positioned at 45 degrees of elevation in relation to the torso.
The Varithena@ canister was activated and the canister was primed and purged as required in the instructions for use. A 2.5 mL aliquot of Varithena@ was drawn into a sterile syringe which was attached to a heparinized saline-filled extension tube for administration of Varithena@ through the tube into the vascular catheter. Varithena@ was slowly administered at 0.5-1.0 cc/second with close observation by ultrasound of its course in the GSV. When Varithena@ delivery arrived at approximately 2 cm from the SFJ, the GSV was then compressed to prevent flow into the common femoral vein. Further administration of Varithena@ was stopped at this point and the treated GSV was observed for spasm with ultrasound over a period of 3—5 minutes. Volume utilized was 3.5 mL, with 2.5 mL administered and 1 mL remaining in the syringe, and cessation of proximal flow was established. The AAGSV was then treated in the same manner, repeating the steps above with 3 mL Varithena6 administered. At this point, previously marked dilated incompetent tortuous Great Saphenous varicosities were treated using image guidance and direct puncture until all varices had been successfully treated or when a maximum volume of 15 mL of Varithena@ had been reached. During administration of Varithena@, the patient was asked to dorsiflex the ankle to limit flow of Varithena@ into perforating veins. Once appropriate spasm had been confirmed in the treated veins, the vascular catheter was removed from the leg and light pressure was applied over the puncture site for hemostasis.
The common femoral and deep superficial veins were then evaluated for flow and compressibility prior to dressing placement. The lower extremity was kept elevated at 45 degrees above the horizontal and cording material was applied over the saphenous segments and tributaries to allow for eccentric compression over the target vessels including the targeted saphenous vein(s). A multilayer dressing was applied using 4" short stretch bandaging, as an under layer, understocking as an over layer, and thigh-high 20—30 mmHg compression elastic support hose were placed on the patient. The leg was lowered only after compression had been applied and the patient was immediately ambulatory. The patient ambulated approximately 10 minutes under supervision and was without apparent concerns at time of release.
Post-care instructions include advising patient to keep post-treatment bandages in place and dry for 48 hours, avoid extended periods of inactivity, avoid heavy exercise for one week, wear compression stockings on the treated leg continuously for two weeks, to walk daily for 10 minutes over the next month. The patient was instructed to take an anti-inflammatory medicine as needed and to follow up for color duplex scan of the GSV, the treated superficial varices, the adjacent deep veins, and additional treatment within 5-7 days. Procedure ended at 10:50 am.
The total length of time to complete Percutaneous Endovenous Ablation with Varithena@ procedure: 10 minutes.
Your answer or response would be appreciated.
Procedure Performed: Ultrasound-guided microfoam chemical ablation with Varithena of the right GSV from below the SFJ to mid-calf access secondary to GSV incompetence.
Anesthesia: Local 1% lidocaine cutaneous anesthetic.
Indications for Procedure: Please refer to clinical notes. Patient has had continuation of symptoms despite 3 months of conservative medical therapy. The patient underwent informed consent including management options where the complications of infection, bleeding, pain, and skin injury were discussed. Particular attention was spent discussing thrombus extension and deep vein thrombosis.
Procedure: The patient walked to the procedure room. Procedure began at 10:40 am. All applicable staff donned appropriate apparel. A procedure timeout was performed to confirm correct patient, correct extremity, correct procedure, and correct room set-up including presence of all applicable supplies, devices, and drugs.
Monitoring devices were appropriately positioned. A duplex ultrasound scan, performed by a registered vascular technologist confirmed the location and incompetence of the GSV and its course marked on the skin together with the dilated tributaries. The extent of treatment of the GSV and the associated varicosities was determined through ultrasound mapping by the treating physician.
The patient was placed on the operating room table and was evaluated in reverse Trendelenburg position. The limb was prepped and sterile drapes were applied. A skin wheal was made to facilitate access using 1.0% lidocaine at the chosen puncture site in the lower thigh overlying the GSV. The skin was punctured through the anesthetized skin with the venous access needle and advanced under ultrasound guidance. Access was established to the target vessel and venous access confirmed by aspiration of dark low pressure blood. Upon gaining all access sites both above and below the knee, the target limb was positioned at 45 degrees of elevation in relation to the torso.
The Varithena@ canister was activated and the canister was primed and purged as required in the instructions for use. A 2.5 mL aliquot of Varithena@ was drawn into a sterile syringe which was attached to a heparinized saline-filled extension tube for administration of Varithena@ through the tube into the vascular catheter. Varithena@ was slowly administered at 0.5-1.0 cc/second with close observation by ultrasound of its course in the GSV. When Varithena@ delivery arrived at approximately 2 cm from the SFJ, the GSV was then compressed to prevent flow into the common femoral vein. Further administration of Varithena@ was stopped at this point and the treated GSV was observed for spasm with ultrasound over a period of 3—5 minutes. Volume utilized was 3.5 mL, with 2.5 mL administered and 1 mL remaining in the syringe, and cessation of proximal flow was established. The AAGSV was then treated in the same manner, repeating the steps above with 3 mL Varithena6 administered. At this point, previously marked dilated incompetent tortuous Great Saphenous varicosities were treated using image guidance and direct puncture until all varices had been successfully treated or when a maximum volume of 15 mL of Varithena@ had been reached. During administration of Varithena@, the patient was asked to dorsiflex the ankle to limit flow of Varithena@ into perforating veins. Once appropriate spasm had been confirmed in the treated veins, the vascular catheter was removed from the leg and light pressure was applied over the puncture site for hemostasis.
The common femoral and deep superficial veins were then evaluated for flow and compressibility prior to dressing placement. The lower extremity was kept elevated at 45 degrees above the horizontal and cording material was applied over the saphenous segments and tributaries to allow for eccentric compression over the target vessels including the targeted saphenous vein(s). A multilayer dressing was applied using 4" short stretch bandaging, as an under layer, understocking as an over layer, and thigh-high 20—30 mmHg compression elastic support hose were placed on the patient. The leg was lowered only after compression had been applied and the patient was immediately ambulatory. The patient ambulated approximately 10 minutes under supervision and was without apparent concerns at time of release.
Post-care instructions include advising patient to keep post-treatment bandages in place and dry for 48 hours, avoid extended periods of inactivity, avoid heavy exercise for one week, wear compression stockings on the treated leg continuously for two weeks, to walk daily for 10 minutes over the next month. The patient was instructed to take an anti-inflammatory medicine as needed and to follow up for color duplex scan of the GSV, the treated superficial varices, the adjacent deep veins, and additional treatment within 5-7 days. Procedure ended at 10:50 am.
The total length of time to complete Percutaneous Endovenous Ablation with Varithena@ procedure: 10 minutes.