Venoplasty lower extremity

dtruelson

Networker
Messages
41
Best answers
0
Hi, this one gave me a headache-any help would be greatly appreciated!!

I got 37238, 37239, 37248, 37249, 36010, 36010, 37252, 37253 X 4, 75822, 75825, 76937, 76937.

PROCEDURE:

Diagnostic venography and interventions

Procedural Personnel
Attending physician(s):
Resident physician(s):

Pre-procedure diagnosis: Recurrent sarcoma
Post-procedure diagnosis: Same
Indication: Other-left iliac vein obstruction
Additional clinical history: None

Complications: No immediate complications.

PROCEDURE SUMMARY:

- Venous access with ultrasound guidance
- Selective venography as described below
- Intravascular ultrasound as described below
- Additional procedure(s): Venous stenting as described below

PROCEDURE DETAILS:


Pre-procedure
Consent: Informed consent for the procedure including risks, benefits and alternatives was obtained and time-out was performed prior to the procedure.
Preparation: The site was prepared and draped using maximal sterile barrier technique including cutaneous antisepsis.

Anesthesia/sedation
Level of anesthesia/sedation: Moderate sedation (conscious sedation)
Anesthesia/sedation administered by: Independent trained observer under attending supervision with continuous monitoring of the patient's level of consciousness and physiologic status

3 mg of Versed
250 mcg of Fentanyl
Total intra-service sedation time (minutes): 227

I was present throughout the sedation period. The patient was monitored continuously 1:1 thought-out the entire procedure by me while sedation was administered.

Access x 2
Local anesthesia was administered. The vessel was sonographically evaluated and determined to be patent. Real time ultrasound was used to visualize needle entry into the vessel and a permanent image was stored. A 9 French sheath was placed.
Vein accessed: Left and right popliteal veins.
Access technique: Micropuncture set with 21 gauge needle

Left venography/intravascular ultrasound
Indication for venography: Evaluate for stenosis, thrombosis, or occlusion
Vein catheterized: Left popliteal vein, femoral vein, iliac vein, IVC
Findings: Patent left popliteal vein, left femoral vein, and proximal most portion of the external iliac vein with extrinsic narrowing just inferior to the left inguinal ligament and narrowing of the left external and common iliac veins in the pelvis
secondary to mass effect. The IVC was patent. Intravascular ultrasound advanced over wire and was used to measure the diameter of the inferior IVC, left common and external iliac veins, and left common femoral vein for selection of stent diameter.

Right venography/intravascular ultrasound
Indication for venography: Evaluate for stenosis, thrombosis, or occlusion
Vein catheterized: Right popliteal vein, right femoral vein, right iliac veins, IVC.
Findings: Patent right popliteal vein, right femoral vein, and right iliac venous vasculature with extrinsic compression of the inguinal ligament and within the pelvis near the level of the inferior margin of the sacroiliac joint. Intravascular
ultrasound was used to measure the diameter of the inferior IVC, right common and external iliac veins, and right common femoral vein for selection of stent diameter.

Left venoplasty
Venoplasty location: Left common femoral vein, left external/common iliac veins, and IVC confluence
Venoplasty balloon: 8 x 80 mm, 10 x 40 mm,
Post-intervention venography: No significant change in venous patency.

Right venoplasty
Venoplasty location: Right common femoral vein, right external/common iliac veins, and IVC confluence
Venoplasty balloon: 8 x 80 mm, 10 x 40 mm
Post-intervention venography: No significant change in venous patency.

Left venous stent placement
Venous stent location: IVC confluence, left common iliac vein, left external iliac vein
Venous stent: Medtronic Abre, 16 x 150mm
Post-stenting venoplasty: 16 mm balloon

Venous stent location: Left external iliac vein to proximal femoral vein
Venous stent: Medtronic Abre, 16 x 100mm
Post-stenting venoplasty: 14mm balloon

Post-stenting venography: Widely patent left iliac venous vasculature without angiographic evidence of narrowing

Right venous stent placement
Venous stent location: IVC confluence, right common iliac vein, extending to proximal segment of the right external iliac vein
Venous stent: Medtronic Abre, 16 x 100mm
Post-stenting venoplasty: 16 mm balloon

Venous stent location: Right common iliac vein, extending to proximal segment of the right external iliac vein
Venous stent: Medtronic Abre, 14 x 80mm
Post-stenting venoplasty: 14 mm balloon

Venous stent location: Right external iliac vein to proximal femoral vein
Venous stent: Medtronic Abre, 14 x 10mm
Post-stenting venoplasty: 14 mm balloon

Post-stenting venography: Widely patent right iliac venous vasculature without angiographic evidence of narrowing. There is now some wall adherent and non occlusive intraluminal thrombus within the superior right femoral vein.

Mechanical or aspiration thrombectomy and venoplasty
Venous segment treated: Proximal right femoral vein
Thrombectomy device: 6 French sheath, 8 x 80 mm balloon
Post-thrombectomy venography: Small amount of wall adherent/ eccentric residual thrombus along the medial margin of the proximal right common femoral vein
 

Jim Pawloski

True Blue
Messages
1,520
Location
Ann Arbor
Best answers
2
I would code 37238-RT, 37239-LT, 36010, 36010-59, 37252, 37253 x 4, 75822-59. Angioplasty is part of stent placement so 37248,49 are not billable, 75825, the IVC findings is not described in the report and should not be coded.

HTH,
Jim Pawloski, CIRCC
 
Top