My codes for the following procedure are
36000(brachial)
76937-26
36000-59(jugular)
77001-26
76937-2659. Can anyone pls confirm whether this is correct.
Procedure: Ultrasound-guided venous access and limited central
venography.
History: 64 year old male with history of end-stage renal
disease, hemodialysis dependent. The patient has known history of
central venous occlusions, and currently receives dialysis via a
tunneled, double lumen right groin dialysis catheter. Referred
for PICC placement if possible or ultrasound guided venous access.
Procedure: A preliminary
ultrasound scan of the right upper arm was performed demonstrating
patent questionable, diminutive brachial vein. With the patient
in the supine position the right upper arm was prepped and draped
in a sterile fashion and the skin and subcutaneous tissues were
infiltrated with local Lidocaine. Under real time ultrasound
guidance, the right brachial vein was punctured numerous times
with a 21 gauge needle. A permanent sonographic recording was
created for the patient's medical record. A 0.018 inch guidewire
was inserted through the needle, however, would not advance
further within the vein. Further attempts of venous access via
the right arm were reported.
Preliminary sonography of the left neck demonstrates a widely
patent internal jugular vein, however, no external jugular vein is
visualized. The left neck and upper chest were prepped and draped
in usual sterile fashion. 1% lidocaine was administered to the
skin and subcutaneous tissues. Using real-time sonographic
guidance, the left internal jugular vein was punctured with a
21-gauge needle. A permanent sonographic recording was created
for the patient's medical record. Under fluoroscopic guidance, a
0.018 inch wire was advanced through the needle, however, would
not advance centrally within the chest. Exchange was made for the
4-French micro-puncture introducer. Limited venography was then
performed, demonstrating total central venous occlusion, with
numerous, abnormal collaterals throughout the paracervical and
intercostal regions.
The 4-French micropuncture introducer was then left within the
left internal jugular vein, to serve as central venous access for
antibiotic therapy. The introducer was flushed with Hep-Lock
solution and secured to the skin with sterile dressings.
The patient tolerated the procedure well and no complications were
encountered. Total fluoroscopy time was 1.0 minutes.
Approximately 20 cc of Isovue 300 were used as intravascular
contrast.
Impression:
Limited left central venography demonstrates complete occlusion at
the origin of the brachiocephalic vein with numerous venous
collaterals about paracervical and intercostal regions.
Ultrasound and fluoroscopy guided placement of a 4 French
micropuncture introducer through the left internal jugular vein
without complication.
36000(brachial)
76937-26
36000-59(jugular)
77001-26
76937-2659. Can anyone pls confirm whether this is correct.
Procedure: Ultrasound-guided venous access and limited central
venography.
History: 64 year old male with history of end-stage renal
disease, hemodialysis dependent. The patient has known history of
central venous occlusions, and currently receives dialysis via a
tunneled, double lumen right groin dialysis catheter. Referred
for PICC placement if possible or ultrasound guided venous access.
Procedure: A preliminary
ultrasound scan of the right upper arm was performed demonstrating
patent questionable, diminutive brachial vein. With the patient
in the supine position the right upper arm was prepped and draped
in a sterile fashion and the skin and subcutaneous tissues were
infiltrated with local Lidocaine. Under real time ultrasound
guidance, the right brachial vein was punctured numerous times
with a 21 gauge needle. A permanent sonographic recording was
created for the patient's medical record. A 0.018 inch guidewire
was inserted through the needle, however, would not advance
further within the vein. Further attempts of venous access via
the right arm were reported.
Preliminary sonography of the left neck demonstrates a widely
patent internal jugular vein, however, no external jugular vein is
visualized. The left neck and upper chest were prepped and draped
in usual sterile fashion. 1% lidocaine was administered to the
skin and subcutaneous tissues. Using real-time sonographic
guidance, the left internal jugular vein was punctured with a
21-gauge needle. A permanent sonographic recording was created
for the patient's medical record. Under fluoroscopic guidance, a
0.018 inch wire was advanced through the needle, however, would
not advance centrally within the chest. Exchange was made for the
4-French micro-puncture introducer. Limited venography was then
performed, demonstrating total central venous occlusion, with
numerous, abnormal collaterals throughout the paracervical and
intercostal regions.
The 4-French micropuncture introducer was then left within the
left internal jugular vein, to serve as central venous access for
antibiotic therapy. The introducer was flushed with Hep-Lock
solution and secured to the skin with sterile dressings.
The patient tolerated the procedure well and no complications were
encountered. Total fluoroscopy time was 1.0 minutes.
Approximately 20 cc of Isovue 300 were used as intravascular
contrast.
Impression:
Limited left central venography demonstrates complete occlusion at
the origin of the brachiocephalic vein with numerous venous
collaterals about paracervical and intercostal regions.
Ultrasound and fluoroscopy guided placement of a 4 French
micropuncture introducer through the left internal jugular vein
without complication.