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CV line placement

  1. Default CV line placement
    Medical Coding Books
    Hello,

    Could someone help me out in coding this report which is driving me nuts?

    --------------------------------------------------------------------------------------
    After obtaining informed written consent the patient was placed supine on the angiographic table.

    Ultrasound-guided vascular access to the patent, yet diminutive right upper arm cephalic vein is obtained. A wire was carefully passed in the cephalic vein at the level of the upper arm.
    Due to difficulty passing the wire centrally, a catheter was advanced into the cephalic vein and venogram was performed. Venogram revealed no evidence of in-line flow. There were multiple upper arm, lower neck and chest wall collaterals. The right upper arm access was then abandoned.


    The right neck was then prepped and draped in sterile fashion. 5 mL of 1% lidocaine was applied for local anesthesia. Under direct ultrasound guidance the right external jugular vein was accessed. The right internal jugular vein proved to be occluded. A wire could not be passed centrally via the right external jugular vein. The right neck and vascular access was abandoned.

    The left neck was then prepped and draped in sterile fashion. Five and also 1% lidocaine was applied for local anesthesia. Under direct ultrasound guidance the patent left internal jugular vein was accessed. Sonographic documentation is obtained. Over-the ?wire exchange is performed for a vascular introducer sheath. A wire was carefully advanced toward the SVC. Due to difficulty passing the wire, a left jugular venogram was performed with the catheter in the left jugular vein. The left brachiocephalic vein was occluded. There was no inline flow into the SVC. Multiple neck and upper chest wall collaterals are present.

    The left groin was prepped and draped in sterile fashion.5mL of 1% lidocaine was then applied for lo9cal anesthesia. Under direct ultrasound guidance the patent left common femoral vein was accessed with the micro puncture set. Sonographic augmentation was obtained. Over-the ?wire exchange is performed for a vascular introducer sheath. A wire was carefully advanced toward the IVC. However the wire was seen crossing multiple collaterals with in the left pelvis. Due to difficulty passing the wire a left femoral venogram was performed with the catheter in the left femoral vein. There were appreciated multiple prominent collaterals arising from the left external iliac and left common iliac vein. The IVC is patent. An IVC filter was present. A peel away sheath was then placed over the wire into the IVC.

    The skin in the left lower quadrant was then prepped and draped in sterile fashion. 5 mL 1% lidocaine was applied for local anesthesia. A small incision was made in the left lower quadrant. A tunnel was created from the incision site to the venotomy site. The catheter was tunneled from the incision site to the venotomy site and subsequently advanced via the peel-away sheath into the IVC.

    The incision sites were closed with dermabond. The tunneled catheter flushed and aspirated freely. The tunneled catheter was secured to the skin.

    Impression:
    Successful U/S guided vascular puncture x 3.
    Successful venograms were performed with catheters in the cephalic, left jugular and left common femoral veins.
    Successful placement of a tunneled catheter via the left common femoral vein approach as described above, the catheter was advanced under fluoroscopic guidance to the IVC.

    --------------------------------------------------------------------------------------

    I have coded

    36558-LT
    75822-26-59
    75860-26
    77001-26-59
    76937-26
    76937-26-59
    76937-26-59
    76937-26-59
    36000-59
    36000-59-RT
    36000-59-LT

    Please clarify this for me ASAP.
    Last edited by Cuteyr; 10-15-2014 at 09:24 AM. Reason: Corrected the Op note

  2. Default
    First, there only seems to be 3 total accesses. The L. Neck access is not documented properly if there really was an access there. Second, the US guidance is not documented properly so you cannot bill for any 76937.

    I would code:

    36558
    36000-50-59 (This will cover the R. arm and R. Neck)
    75820-26 (R. arm venogram)
    75860-26-59 (Jugular Venogram)
    77001-59

  3. Default Sorry...There was a mistake in the OP note
    Hello mikereyland,

    Thanks for your reply.
    I apologize for missing few lines in the OP note. i have added them now.
    Please check and give your codes for the same.

    Thanks again

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