kvo
Networker
I could use some help in clarifying how a procedure should be coded, more specifically the catheter placements to code. The codes that were given were, 36005, 36011, 37238, 37252, 37253 x 4, 75822, 76937 x 2.
PROCEDURE:
US guided access of Left femoral vein.
US guided access of Right femoral vein.
Pelvic venogram.
IVUS evaluation of caudal inferior vena cava, right and left common and external iliac veins, right and left common femoral veins.
Placement of left common iliac vein stent.
Patient was placed supine frog leg position on the procedure table. Right and left groin and upper thigh regions prepped and draped in usual sterile fashion. Following administration of 1% lidocaine, a 21 G micropuncture needle was advanced into each femoral vein under ultrasound guidance. Permanent ultrasound images were stored for documentation purposes. 8F 11cm Merit sheaths were placed initially. Contrast was injected by hand via sheaths and pelvic venogram was obtained. 0.035 Bentson wires were then advanced centrally under fluoroscopy into the IVC. Subsequently a Volcano digital IVUS catheter was advanced over the guidewire and intravascular ultrasound images of the caudal aspect of the inferior vena cava, right and left common iliac veins, right and left external iliac veins, right and left common femoral veins were obtained. Images were reviewed.
FINDINGS:
Venogram obtained demonstrated patency of the caudal aspect of the IVC. No IVC filter. Visualized iliofemoral veins are patent. Some left-sided pelvic collaterals are seen to fill. Subtle luminal irregularity of the left common iliac vein venographically.
IVUS images demonstrated patency of the caudal aspect of the inferior vena cava. Luminal area 212 mm².
IVUS images demonstrated patency of the right common iliac vein. Luminal area calculated at 109 mm². There was patency of the right external iliac vein. Luminal area 102 mm². The right common femoral vein was patent. Luminal area 95 mm².
IVUS images demonstrate patency of the left common iliac vein at origin. Luminal area was calculated at 147 mm². Slightly distal to the origin was some luminal irregularity and intraluminal webbing. Luminal area reduced to 69.9 mm². Distal left common iliac vein was distended. Luminal area 171 mm². There was patency of the left external iliac vein. Luminal area 114 mm². The left common femoral vein was patent. Luminal area 82 mm².
INTERVENTION:
Patient was given heparin IV. Sheath on the left were exchanged over Amplatz wire for an 10F sheath. Subsequently an 14 mm x 120 mm Medtronic Abre stent was deployed across the left common iliac vein lesion. The stent was postdilated with a 14 mm Atlas balloon. Follow-up venogram demonstrated appropriate positioning of the stent with brisk flow. Postprocedure IVUS images demonstrated appropriate wall appositioning of the stent with improvement in luminal area of left common iliac vein now measuring 150.6 mm². Catheters were removed over a guidewire. Both sheaths were removed. Hemostasis was achieved with manual compression.
Patient tolerated the procedure well. No acute complications. Patient will continue anticoagulation medication Xarelto. Patient will initiate antiplatelet therapy with Plavix, starting today. Follow-up visit in one month.
IMPRESSION:
Flow-limiting old post-thrombotic changes of the left common iliac vein.
Successful endovascular stent deployment with improvement in luminal area of left common iliac vein as described and discussed above
PROCEDURE:
US guided access of Left femoral vein.
US guided access of Right femoral vein.
Pelvic venogram.
IVUS evaluation of caudal inferior vena cava, right and left common and external iliac veins, right and left common femoral veins.
Placement of left common iliac vein stent.
Patient was placed supine frog leg position on the procedure table. Right and left groin and upper thigh regions prepped and draped in usual sterile fashion. Following administration of 1% lidocaine, a 21 G micropuncture needle was advanced into each femoral vein under ultrasound guidance. Permanent ultrasound images were stored for documentation purposes. 8F 11cm Merit sheaths were placed initially. Contrast was injected by hand via sheaths and pelvic venogram was obtained. 0.035 Bentson wires were then advanced centrally under fluoroscopy into the IVC. Subsequently a Volcano digital IVUS catheter was advanced over the guidewire and intravascular ultrasound images of the caudal aspect of the inferior vena cava, right and left common iliac veins, right and left external iliac veins, right and left common femoral veins were obtained. Images were reviewed.
FINDINGS:
Venogram obtained demonstrated patency of the caudal aspect of the IVC. No IVC filter. Visualized iliofemoral veins are patent. Some left-sided pelvic collaterals are seen to fill. Subtle luminal irregularity of the left common iliac vein venographically.
IVUS images demonstrated patency of the caudal aspect of the inferior vena cava. Luminal area 212 mm².
IVUS images demonstrated patency of the right common iliac vein. Luminal area calculated at 109 mm². There was patency of the right external iliac vein. Luminal area 102 mm². The right common femoral vein was patent. Luminal area 95 mm².
IVUS images demonstrate patency of the left common iliac vein at origin. Luminal area was calculated at 147 mm². Slightly distal to the origin was some luminal irregularity and intraluminal webbing. Luminal area reduced to 69.9 mm². Distal left common iliac vein was distended. Luminal area 171 mm². There was patency of the left external iliac vein. Luminal area 114 mm². The left common femoral vein was patent. Luminal area 82 mm².
INTERVENTION:
Patient was given heparin IV. Sheath on the left were exchanged over Amplatz wire for an 10F sheath. Subsequently an 14 mm x 120 mm Medtronic Abre stent was deployed across the left common iliac vein lesion. The stent was postdilated with a 14 mm Atlas balloon. Follow-up venogram demonstrated appropriate positioning of the stent with brisk flow. Postprocedure IVUS images demonstrated appropriate wall appositioning of the stent with improvement in luminal area of left common iliac vein now measuring 150.6 mm². Catheters were removed over a guidewire. Both sheaths were removed. Hemostasis was achieved with manual compression.
Patient tolerated the procedure well. No acute complications. Patient will continue anticoagulation medication Xarelto. Patient will initiate antiplatelet therapy with Plavix, starting today. Follow-up visit in one month.
IMPRESSION:
Flow-limiting old post-thrombotic changes of the left common iliac vein.
Successful endovascular stent deployment with improvement in luminal area of left common iliac vein as described and discussed above