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Bilateral multi-sidehole infusion catheters

  1. Default Bilateral multi-sidehole infusion catheters
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    Bilateral infusion cathaters are placed in both legs should i need to code 37201 twice, please confirm.

    The patient was placed prone on the angiography table.
    Preliminary ultrasound demonstrated thrombus within the bilateral
    popliteal veins. The bilateral popliteal regions were prepped and
    draped in the usual sterile manner. Local anesthesia was achieved
    with 1% lidocaine. Under real-time ultrasound guidance the
    bilateral popliteal veins were accessed with a micropuncture set.
    A sonographic recording was made for patient's medical record.
    Bilateral 9-French sheaths were placed.

    Findings:

    Contrast was injected demonstrating extensive clot extending from
    the bilateral popliteal veins to the inferior vena cava. Clots is
    seen extending slightly above the apex of the most inferior
    inferior vena cava filter.

    Intervention:

    Bentson wires were advanced through the sheaths and into the
    inferior vena cava, above the IVC filter. Mechanical and
    pharmacologic thrombectomy was performed with the Trellis
    catheter. On the left the catheter was advanced with proximal
    balloon in the inferior vena cava, above the inferior filter.
    Four runs were performed, extending down to the popliteal vein,
    with a total of 14 mg of TPA. On the right the catheter was
    advanced with the proximal balloon in the right common iliac vein.
    Three runs were performed, extending down to the popliteal vein,
    with a total of 15 mg of TPA. Repeat contrast injection through
    both sheaths demonstrated slight improvement with significant
    residual thrombus. An Omni flush catheter was advanced to the
    level of the inferior vena cava, just above the bifurcation.
    Contrast was injected and digital subtraction angiography was
    performed demonstrating improvement, however significant residual
    thrombus within the inferior vena cava and in the inferior IVC
    filter.

    At this point there was a discussion with the neuro- ICU attending
    and Dr.xxx. Given risks and benefits, it was decided to place
    multi-side hole infusion catheters and infused TPA overnight in
    order to give patient potential for more complete thrombolysis.

    Bilateral Cragg-McNamara infusion catheters, with 50-cm infusion
    length, were advanced. On the left the catheter extended from the
    apex of the inferior IVC filter to the mid femoral vein. On the
    right the catheter extended from the right common iliac vein to
    the distal femoral vein, at the level of the distal tibia.
    Occlusion wires were placed through the bilateral catheters. TPA
    was infused at a concentration of 0.5 mg/hr. Heparinized saline
    was infused through the bilateral sheath. The sheaths were
    sutured in place. Sterile dressings were applied bilaterally.

    Plan is to allow infusion overnight and pull infusion catheters
    and sheaths in 24 hours, in the intensive care unit.


    Impression:

    Bilateral venograms demonstrating extensive thrombus extending
    from the bilateral popliteal veins to the inferior vena cava,
    above the inferior IVC filter.

    Pharmacologic and mechanical thrombectomy performed with the
    Trellis catheter and a total of 29 mg TPA. Repeat venogram
    demonstrates improvement, however significant residual thrombus
    extending from the bilateral popliteal veins to the inferior vena
    cava.

    Bilateral multi-sidehole infusion catheters placed with 50-cm
    infusion length and occlusion wires. Infusion of TPA performed at
    0.5 mg/hr.
    Last edited by Shirleybala; 05-14-2009 at 12:08 AM.

  2. #2
    Default
    I'm thinking 37187 on the left and 75896/37201 on the right...

  3. Default
    Yes, 37201 x2 since they're separate.

    Diane Huston, CPC,RCC

  4. #4
    Default
    yes, you're both correct, 75896/37201x2 and the 37187

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