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  1. Default 3 access
    Exam Training Packages
    Hello plz confirm these codes work on below documentation
    36556
    36011
    36011-59
    76937-26
    76937-2659
    76937-2659
    Procedure: Non-tunneled hemodialysis catheter placement, left
    common femoral vein sheath, left internal jugular vein sheath

    Initially the procedure was discussed with the patient including
    risks, benefits and alternatives. Risks discussed included but
    were not limited to bleeding, infection, venous thrombosis and
    occlusion. The patient appeared to understand, asked appropriate
    questions \T\ signed informed consent. 0.5 Minutes fluoroscopy
    time. The patient received IV Versed and fentanyl for conscious
    sedation and analgesia, administered and monitored by the
    interventional radiology nurse.

    Preliminary ultrasound of the right groin, left groin and left
    internal jugular vein demonstrates patency of the right femoral
    vein, left femoral vein and left internal jugular vein. The
    bilateral groins and left neck were then prepped and draped in the
    usual sterile manner and locally anesthetized with one percent
    lidocaine. Under real-time ultrasound guidance, the right femoral
    vein was accessed with a micropuncture set. A sonographic
    recording was made for patient's medical record. An Amplatz wire
    was then advanced into the inferior vena cava. The tract was then
    dilated, and a 14 Fr 24 cm long Schon XL vascath was placed,
    catheter tips in the inferior vena cava. Good bidirectional flow
    was noted from both lumens, which were locked with heparin
    solution. The catheter was sutured in place with 2-0 prolene and
    a sterile dressing applied.

    Under real-time ultrasound guidance, the left femoral vein was
    accessed with a micropuncture set. A sonographic recording was
    made for patient's medical record. An Amplatz wire was advanced
    into the inferior vena cava. The tract was then dilated, and an
    8-French sheath was placed. The tip of the sheath is in the left
    iliac vein. The sheath was flushed with saline. A sterile
    dressing was then applied.

    Under real-time ultrasound guidance, the right internal jugular
    vein was accessed with a micropuncture set. A sonographic
    recording was made for patient's medical record. An Amplatz wire
    was advanced, the tract was dilated and a 5-French sheath was
    placed. The tip of the sheath is in the left brachiocephalic
    vein. The sheath was flushed with saline. The sheath was secured
    to the skin with 2-0 Prolene a sterile dressing applied.

    The patient tolerated the procedure well, left the department in
    stable condition. No immediate complications.

    Impression:

    SUCCESSFUL PLACEMENT OF RIGHT FEMORAL 24 CM LONG
    SCHON XL VASCATH, CATHETER TIP IN INFERIOR VENA CAVA.

    SUCCESSFUL PLACEMENT OF 8 FRENCH SHEATH IN LEFT FEMORAL VEIN WITH
    TIP IN LEFT ILIAC VEIN.

    SUCCESSFUL PLACEMENT OF 5 FRENCH SHEATH IN LEFT INTERNAL JUGULAR
    VEIN WITH TIP IN BRACHIOCEPHALIC VEIN.

  2. #2
    Default
    sounds like 3 central lines...it'll depend on what they're (sheaths) are being used for...


    "If they are used as central lines (which they frequently are) then they should be considered as such.
    If they are used as portals for other catheters (such as a Swan) then unfortunately they are not considered central lines." (per a physician I work for)
    Last edited by MLS2; 05-28-2009 at 09:15 AM.

  3. #3
    Location
    Birmingham, Alabama
    Posts
    889
    Default
    Quote Originally Posted by Shirleybala View Post
    Hello plz confirm these codes work on below documentation
    36556
    36011
    36011-59
    76937-26
    76937-2659
    76937-2659
    Procedure: Non-tunneled hemodialysis catheter placement, left
    common femoral vein sheath, left internal jugular vein sheath

    Initially the procedure was discussed with the patient including
    risks, benefits and alternatives. Risks discussed included but
    were not limited to bleeding, infection, venous thrombosis and
    occlusion. The patient appeared to understand, asked appropriate
    questions \T\ signed informed consent. 0.5 Minutes fluoroscopy
    time. The patient received IV Versed and fentanyl for conscious
    sedation and analgesia, administered and monitored by the
    interventional radiology nurse.

    Preliminary ultrasound of the right groin, left groin and left
    internal jugular vein demonstrates patency of the right femoral
    vein, left femoral vein and left internal jugular vein. The
    bilateral groins and left neck were then prepped and draped in the
    usual sterile manner and locally anesthetized with one percent
    lidocaine. Under real-time ultrasound guidance, the right femoral
    vein was accessed with a micropuncture set. A sonographic
    recording was made for patient's medical record. An Amplatz wire
    was then advanced into the inferior vena cava. The tract was then
    dilated, and a 14 Fr 24 cm long Schon XL vascath was placed,
    catheter tips in the inferior vena cava. Good bidirectional flow
    was noted from both lumens, which were locked with heparin
    solution. The catheter was sutured in place with 2-0 prolene and
    a sterile dressing applied.

    Under real-time ultrasound guidance, the left femoral vein was
    accessed with a micropuncture set. A sonographic recording was
    made for patient's medical record. An Amplatz wire was advanced
    into the inferior vena cava. The tract was then dilated, and an
    8-French sheath was placed. The tip of the sheath is in the left
    iliac vein. The sheath was flushed with saline. A sterile
    dressing was then applied.

    Under real-time ultrasound guidance, the right internal jugular
    vein was accessed with a micropuncture set. A sonographic
    recording was made for patient's medical record. An Amplatz wire
    was advanced, the tract was dilated and a 5-French sheath was
    placed. The tip of the sheath is in the left brachiocephalic
    vein. The sheath was flushed with saline. The sheath was secured
    to the skin with 2-0 Prolene a sterile dressing applied.

    The patient tolerated the procedure well, left the department in
    stable condition. No immediate complications.

    Impression:

    SUCCESSFUL PLACEMENT OF RIGHT FEMORAL 24 CM LONG
    SCHON XL VASCATH, CATHETER TIP IN INFERIOR VENA CAVA.

    SUCCESSFUL PLACEMENT OF 8 FRENCH SHEATH IN LEFT FEMORAL VEIN WITH
    TIP IN LEFT ILIAC VEIN.

    SUCCESSFUL PLACEMENT OF 5 FRENCH SHEATH IN LEFT INTERNAL JUGULAR
    VEIN WITH TIP IN BRACHIOCEPHALIC VEIN.

    Well, I do wonder what the sheath's are for? Without more clarity here is how I would code:

    36556
    36000-59 (sheaths and catheters are not neccesarily the same thing)
    36000-59
    77001
    76937 (this code description says potential access site(s)--plural, so I would only code once per session.

    I hope this helps.
    Danny L. Peoples
    CIRCC,CPC

  4. #4
    Default
    I concur

  5. Default
    Thankyou,

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