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Thread: right brachial artery was inadvertently punctured,

  1. #1

    Default right brachial artery was inadvertently punctured,

    AAPC: Back to School
    How to code this report, my codes are
    77001 26
    76937 26

    Procedure: Informed consent was obtained prior to the procedure.
    Risks discussed included but were not limited to bleeding,
    infection, venous thrombosis etc... A preliminary ultrasound
    scan of the right upper arm was performed demonstrating patent
    brachial and basilic veins. 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 sonographic guidance, the
    right brachial artery was inadvertently punctured, and over a
    wire, a 4.5-French peel-away sheath was placed. Under
    fluoroscopic guidance, evaluation of the wire demonstrates an
    arterial location. Subsequently, the 4.5-French peel-away sheath
    was removed. Hemostasis was achieved after 30 minutes of manual
    compression to the brachial artery. Follow-up sonographic
    evaluation demonstrates a patent artery without evidence of
    periarterial hematoma.

    Subsequently, under real time ultrasound guidance, the right
    basilic vein was punctured with a 21 gauge needle. A permanent
    recording was created for the patient's record. A 0.018 inch
    guidewire was inserted through the needle which was exchanged for
    a 4.5 French peel-away sheath. A 4 French single lumen Power PICC
    catheter was then cut to 41 cm length and inserted through the
    peel-away sheath and advanced to the chest. The catheter tip was
    positioned at the junction of the superior vena cava and right
    atrium. The peel-away sheath was removed. The catheter was
    flushed with Heplock solution and secured to the skin with 2-0
    prolene sutures. A sterile dressing was applied.

    The patient tolerated the procedure well. Total fluoroscopy time
    was 0.7 minutes. No intravenous contrast material was utilized.

    Inadvertent puncture of the right brachial artery with placement
    of a 4.5-French peel-away sheath. The sheath was withdrawn, and
    hemostasis achieved with manual compression. The patient's right
    arm was immobilized for 6 hours after PICC line insertion.

    Ultrasound and fluoroscopy guided placement of a 4 French 41 cm
    long single lumen Bard Power PICC catheter inserted through the
    right basilic vein without complication.
    Shirley CPC,CPC-H

  2. #2


    you'll probably get different answers on this one, but I don't think I would bill for that arterial puncture...It doesn't sound like they "meant" to do that. There was no medical necessity to puncture the artery. I do agree with your other codes.
    Last edited by MLS2; 01-22-2009 at 07:17 AM.

  3. #3
    Join Date
    Apr 2007
    Birmingham, Alabama


    You should not bill for the inadvertant arterial puncture. 1) it was not intented and 2) there is no medical neccessity.

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