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Picc line - Can we code the below

  1. Default Picc line - Can we code the below
    Medical Coding Books
    Can we code the below procedure with
    36569
    36000-5950
    76937-26
    75822-26.

    After obtaining informed, written consent the patient was placed
    in the supine position and the right arm region was prepped and
    draped in the usual sterile fashion.

    After the administration of local anesthesia and under ultrasound
    guidance, a brachial vein was then accessed several cm above the
    elbow using a 21 gauge micropuncture needle. An 018 inch
    guidewire was advanced through the needle and into the vein but
    multiple attempts to advance a wire centrally were unsuccessful.
    The needle was exchanged for a 5.5 French sheath. A gentle
    injection of contrast and performed which demonstrated narrowing
    and tortuosity of the brachial vein. Multiple attempts to advance
    and 018 Glidewire beyond the tortuous vein and into the central
    veins of the chest were unsuccessful. The sheath was removed and
    hemostasis obtained with direct manual compression. A sterile
    dressing was applied over the skin entry site.

    The left arm region was then prepped and draped in the usual
    sterile fashion.

    After the administration of local anesthesia and under ultrasound
    guidance, a brachial vein was accessed several centimeters above
    the elbow using a 21-gauge micropuncture needle. An 018 inch
    guidewire was advanced through the needle and into the vein and
    advanced centrally. The needle was removed and exchanged for a
    5.5 French peel-away sheath. A 5 French single lumen Power PICC
    line was cut to 41 cm in length and advanced through the peel-away
    sheath but failed to advance beyond the humeral head. The PICC
    line was pulled back and a gentle injection of contrast was
    performed. This demonstrated occlusion of the central brachial
    veins with filling of collateral vessels which appeared to empty
    into the central basilic vein/axillary vein. An area of
    extravasation just central to the skin entry site was identified.

    The wire and peel-away sheath were removed. Hemostasis was
    obtained with direct manual compression.

    After the administration of local anesthesia and under ultrasound
    guidance, the basilic vein was accessed several centimeters above
    the elbow using 21-gauge micropuncture needle. An 018 inch
    guidewire was advanced through the needle and advanced centrally.
    The needle was removed and exchanged for a 5.5-French peel-away
    sheath. A 5-French single lumen power PICC line was cut to 39 cm
    in length, advanced through the peel-away sheath and positioned at
    the atrial caval junction. The peel away sheath was then removed.

    Post procedure imaging of the chest was performed demonstrating
    the distal catheter tip overlying at the atrial caval junction in
    good position.

    Impression:
    Successful placement of a 5 French single lumen Power PICC line
    via the left basilic vein as described above.

    Narrowing and tortuosity of the right brachial vein with
    unsuccessful attempt to advance an 018 wire centrally into the
    draining veins of the chest as described above.

    Occlusion of the central left brachial veins with filling of
    multiple collateral veins which empty into the central basilic
    vein/axillary vein as described above.
    Prabha CPC

  2. #2
    Default
    Quote Originally Posted by prabha View Post
    Can we code the below procedure with
    36569
    36000-5950
    76937-26
    75822-26.

    After obtaining informed, written consent the patient was placed
    in the supine position and the right arm region was prepped and
    draped in the usual sterile fashion.

    After the administration of local anesthesia and under ultrasound
    guidance, a brachial vein was then accessed several cm above the
    elbow using a 21 gauge micropuncture needle. An 018 inch
    guidewire was advanced through the needle and into the vein but
    multiple attempts to advance a wire centrally were unsuccessful.
    The needle was exchanged for a 5.5 French sheath. A gentle
    injection of contrast and performed which demonstrated narrowing
    and tortuosity of the brachial vein. Multiple attempts to advance
    and 018 Glidewire beyond the tortuous vein and into the central
    veins of the chest were unsuccessful. The sheath was removed and
    hemostasis obtained with direct manual compression. A sterile
    dressing was applied over the skin entry site.

    The left arm region was then prepped and draped in the usual
    sterile fashion.

    After the administration of local anesthesia and under ultrasound
    guidance, a brachial vein was accessed several centimeters above
    the elbow using a 21-gauge micropuncture needle. An 018 inch
    guidewire was advanced through the needle and into the vein and
    advanced centrally. The needle was removed and exchanged for a
    5.5 French peel-away sheath. A 5 French single lumen Power PICC
    line was cut to 41 cm in length and advanced through the peel-away
    sheath but failed to advance beyond the humeral head. The PICC
    line was pulled back and a gentle injection of contrast was
    performed. This demonstrated occlusion of the central brachial
    veins with filling of collateral vessels which appeared to empty
    into the central basilic vein/axillary vein. An area of
    extravasation just central to the skin entry site was identified.

    The wire and peel-away sheath were removed. Hemostasis was
    obtained with direct manual compression.

    After the administration of local anesthesia and under ultrasound
    guidance, the basilic vein was accessed several centimeters above
    the elbow using 21-gauge micropuncture needle. An 018 inch
    guidewire was advanced through the needle and advanced centrally.
    The needle was removed and exchanged for a 5.5-French peel-away
    sheath. A 5-French single lumen power PICC line was cut to 39 cm
    in length, advanced through the peel-away sheath and positioned at
    the atrial caval junction. The peel away sheath was then removed.

    Post procedure imaging of the chest was performed demonstrating
    the distal catheter tip overlying at the atrial caval junction in
    good position.

    Impression:
    Successful placement of a 5 French single lumen Power PICC line
    via the left basilic vein as described above.

    Narrowing and tortuosity of the right brachial vein with
    unsuccessful attempt to advance an 018 wire centrally into the
    draining veins of the chest as described above.

    Occlusion of the central left brachial veins with filling of
    multiple collateral veins which empty into the central basilic
    vein/axillary vein as described above.
    You have 36005-50 for extremity needle, 75822 for bilateral extremity venogram, and 36569 for picc placement, 77001 for fluoroscopic placement. Since they do not state that a hard copy image was taken with the U/S and you need documentation for the U/S, you cannot charge 76937.

    Thanks, Jim

  3. #3
    Location
    Birmingham, Alabama
    Posts
    889
    Default
    Quote Originally Posted by Jim Pawloski View Post
    You have 36005-50 for extremity needle, 75822 for bilateral extremity venogram, and 36569 for picc placement, 77001 for fluoroscopic placement. Since they do not state that a hard copy image was taken with the U/S and you need documentation for the U/S, you cannot charge 76937.

    Thanks, Jim
    I agree completely. But you will probably need modifier 59 on 36005/75822.

    HTH
    Danny L. Peoples
    CIRCC,CPC

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