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Thread: Tips revision

  1. #1

    Default Tips revision

    AAPC: Back to School
    Hello all:
    How to code this
    I have coded as (37183, 36580)Is ths enough or i have to code it as stent placement vascular(37205)Please clarify.

    The patient already had a right IJ triple lumen catheter in place.
    The right neck and existing catheter were prepped and draped in
    the usual sterile manner and locally anesthetized with 1%
    lidocaine. IV Versed and fentanyl were administered for conscious
    sedation and analgesia, patient was monitored by the
    interventional radiology nurse.

    The existing central line was exchanged over a Rosen wire and a
    6-French 55-cm long bright tip sheath was placed. A 5-French
    Cobra catheter and angled Glidewire were then used to selectively
    catheterize the tips shunt. Contrast was injected and digital
    subtraction angiography was performed in multiple oblique

    . However, there is a weblike
    stenosis in the hepatic vein above the tips
    After measuring the size of the existing TIPS shunt, it was
    elected to extend the shunt further into the hepatic vein with a
    10-mm diameter by 6-cm long fluency covered stent. The fluency
    was deployed extending approximately 1.5 cm further into the
    hepatic vein. The stent was then post dilated to 10 mm.
    Completion angiography was then performed, demonstrating improved
    flow through the TIPS shunt. Additionally, the previously noted
    opacification of the gastroesophageal varices was no longer

    Pressures were obtained, measured in the portal vein and in the
    inferior vena cava. There is still an approximately 14-mm Hg
    porto-systemic gradient at completion. However, the stent cannot
    be extended further into the hepatic vein safely, and the TIPS
    shunt itself is widely patent. It was unclear what could be done
    in order to further reduce the gradient. Additionally,
    angiographically the flow was much improved and the varices are no
    longer filling. It was elected to stop at this time.

    At completion the existing 9-French sheath that had been placed
    was exchanged out for a triple lumen catheter, catheter tip
    positioned at the cavoatrial junction. The catheter was sutured
    in place, locked with heparin solution a sterile dressing applied.
    The patient tolerated the procedure well, left the department in
    stable condition.
    Shirley CPC,CPC-H

  2. #2


    I would think that 37183 would cover the entire revision and additional stent.

  3. #3


    Shirley CPC,CPC-H

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