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Thread: Venography help needed!

  1. #1
    Join Date
    Apr 2007
    Dallas, GA

    Default Venography help needed!

    AAPC: Back to School
    Can someone check my codes?



    INDICATION: Extensive bilateral lower extremity DVT and caval DVT status post TPA EKOS thrombolytic infusion.

    COMPARISON: Venography (Prior day)

    TECHNIQUE: Written informed consent was obtained from the patient prior to proceeding. The patient was brought into the interventional angiographic suite and placed in the supine position. Initial image obtained was through an injection through the existing right groin sheath. This injection showed fill of a thinly patent iliac vein and thinly patent IVC. Clot along the wall of the IVC is demonstrated and there is clot involving the proximal aspect of the external iliac vein at and just beyond the groin sheath tip. Overall clot burden is significantly improved.

    There was stasis of contrast without outflow of washout of contrast from the iliac vein or IVC.

    Following this the left groin sheath was injected also showing stasis of contrast and moderately extensive clot burden to involve the external iliac vein and common iliac vein. There was, however, flow into the IVC and there was some washout demonstrated with this injection. Next the left popliteal sheath was injected and this showed patency of the popliteal vein with persistent clot nonocclusive within the distal most superficial femoral vein. There is rapid flow, however, into collateral veins and superficial veins into the profunda venous system and where the left groin sheath enters the common femoral vein there is chronic occlusion with clot formation. There is faint filling of numerous venous varices which have formed in the deep pelvis and this is undergone little improvement since the previous images.

    Following this was decided to assist the reestablishment of flow into the iliac veins and common femoral veins as well as IVC with angioplasty. This was accomplished with 8mm x 4 cm balloons within the iliac systems and 12 mm x 4 cm balloon within the IVC. This did result in some clot propagation to the cone of the IVC filter. There was an acceptable amount of clot within the cone of the IVC filter with rapid flow around this clot. There was improved patency and washout established both left and right iliac veins and common femoral veins following angioplasty. There was rapid flow and washout into the IVC following angioplasty despite the presence of clot within filter.

    It was decided to discontinue TPA infusion. Heparinization was also discontinued. Once at appropriate anticoagulation levels both left and right groin sheaths and the popliteal sheath were removed without difficulty with hemostasis being achieved. The patient was transferred to the ICU in stable condition. Case discussed with Dr. Box. Systemic anticoagulation will be reinstituted without bolus in 2 to 3 hours.

    IMPRESSION: Successful TPA EKOS thrombolysis with reestablishment of flow into right and left common femoral veins and iliac veins as well as the IVC. There was some clot propagation trapped by the filter with an acceptable amount within the cone of the filter in this patient who will be continued on anticoagulation. No significant change is recognized in the chronic occlusion of the left superficial femoral vein.

  2. #2


    Only code the angioplasty once per operative field. The report does not support multiple operative fields for the interventional portion so I wouldn't charge it twice.
    The rest of your codes are correct.
    Anita W, CIRCC, RCC, CPMA, CPC

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