HISTORY: The patient has poor flow through the current dialysis catheter. Patient has known MRSA infection.
EXAM: Right IJ catheter exchange with creation of a new tunnel MEDICATIONS: Versed 3 mg, Fentanyl 100 mcg
PROCEDURE IN DETAIL: Informed consent was obtained. The right IJ catheter was prepped and draped in sterile fashion. Lidocaine 1% was used for local anesthesia. After exposing the catheter via a cut down near the venotomy, the catheter was divided and a stiff glidewire was passed through one lumen of the remaining proximal part of the catheter into the IVC. The old catheter was removed in its entirety (visual inspection assured the catheter was removed intact.) Next, SVC angiogram was performed. There was no significant sheath stenosis formation and the SVC appeared normal. Next, a new tunnel was created (via the direction) and a new catheter, from tip to cuff, in total length, was exchanged over the guidewire and the tip was positioned in the right atrium using fluoroscopic guidance. A 2-0 prolene suture was placed at the catheter exit site and vicryl suture was used to close the venotomy site. Both ports flushed and aspirated easily and were subsequently packed with heparin. 10cc contrast was used.
IMPRESSION: Successful exchange of the right internal jugular vein catheter with no significant fibrin sheath stenosis noted on SVC angiogram. A new tunnel and exit site were created.

My Dr & I are at a disagreement. I believe it should be 36581 77001. he says that a new tunnel is new placement 36558 36589 77001. does anyone know what is correct & where I can find the reference? I have loked and cannot find.