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Help coding Infusion for Thrombolysis and Catherization

  1. #1
    Default Help coding Infusion for Thrombolysis and Catherization
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    Good morning. I need a little help coding this report. I'm always unsure when it comes to catheters. Should I just code the IVC since the catheter was withdrawn not advanced or should I code where it ended? I was going to go with

    37201
    36010 or 36247?
    75825-26
    75820-26
    75820-26-59
    75896-26

    a 21 gauge needle was placed into the popliteal vein clot with ultrasound and fluoroscopic guidance. The tract was dilated to accommodate a 4 French coaxial dilator. An angle Glidewire was advanced into the inferior vena cava. A 5 French sheath was placed and through this, a 4 French angled glide
    catheter was advanced to the inferior vena cava. Inferior venacavogram
    shows patent IVC. With catheter withdrawn to the mid common iliac vein,
    venography shows patent common iliac vein. The catheter was withdrawn to
    the upper femoral vein and shows patent iliac vein. The catheter was
    withdrawn to the low common femoral vein and venogram shows patent common femoral vein. However when the catheter was withdrawn into the proximal superficial femoral vein, clots within the superficial femoral vein is
    demonstrated which ends at the junction with the common femoral vein. The
    length of the clot as measured from the tip of the sheath was 29 cm.
    Therefore a 30 cm sidehole Cragg McNamara 5 French infusion catheter was
    placed with sideholes located within the clotted portion of the vein.
    Retavase infusion with concentration of one unit per 100 cc was initiated
    at a rate 0.5 units per hour into the Cragg McNamara catheter and another
    0.5 units per hour of Retavase was infused into the sheath. The catheter
    and sheath were secured to the skin using Tegaderm. The patient was then
    transferred to ICU.
    IMPRESSION:
    1. Thrombus within the left popliteal and superficial femoral vein with
    patent common femoral vein and iliac vein.
    2. Coaxial infusion with Craig McNamara 30 cm sidehole catheter and 6
    French sheath was initiated from the popliteal vein along the entire left
    superficial femoral vein thrombus.
    3. IV infusion of heparin at 400 units per hour was initiated.

  2. #2
    Default
    Quote Originally Posted by drobinson1 View Post
    Good morning. I need a little help coding this report. I'm always unsure when it comes to catheters. Should I just code the IVC since the catheter was withdrawn not advanced or should I code where it ended? I was going to go with

    37201
    36010 or 36247?
    75825-26
    75820-26
    75820-26-59
    75896-26

    a 21 gauge needle was placed into the popliteal vein clot with ultrasound and fluoroscopic guidance. The tract was dilated to accommodate a 4 French coaxial dilator. An angle Glidewire was advanced into the inferior vena cava. A 5 French sheath was placed and through this, a 4 French angled glide
    catheter was advanced to the inferior vena cava. Inferior venacavogram
    shows patent IVC. With catheter withdrawn to the mid common iliac vein,
    venography shows patent common iliac vein. The catheter was withdrawn to
    the upper femoral vein and shows patent iliac vein. The catheter was
    withdrawn to the low common femoral vein and venogram shows patent common femoral vein. However when the catheter was withdrawn into the proximal superficial femoral vein, clots within the superficial femoral vein is
    demonstrated which ends at the junction with the common femoral vein. The
    length of the clot as measured from the tip of the sheath was 29 cm.
    Therefore a 30 cm sidehole Cragg McNamara 5 French infusion catheter was
    placed with sideholes located within the clotted portion of the vein.
    Retavase infusion with concentration of one unit per 100 cc was initiated
    at a rate 0.5 units per hour into the Cragg McNamara catheter and another
    0.5 units per hour of Retavase was infused into the sheath. The catheter
    and sheath were secured to the skin using Tegaderm. The patient was then
    transferred to ICU.
    IMPRESSION:
    1. Thrombus within the left popliteal and superficial femoral vein with
    patent common femoral vein and iliac vein.
    2. Coaxial infusion with Craig McNamara 30 cm sidehole catheter and 6
    French sheath was initiated from the popliteal vein along the entire left
    superficial femoral vein thrombus.
    3. IV infusion of heparin at 400 units per hour was initiated.
    I agree with all of you codes except for the second 75820. IMO this was an IVCgram, and extremity venogram unilateral, with thrombolysis infusion.
    Nice coding!!

    Thanks,
    Jim

  3. Default
    With reference to the catheter code I would suggest 36010 rather than 36247.
    Prabha CPC

  4. #4
    Default
    Quote Originally Posted by prabha View Post
    With reference to the catheter code I would suggest 36010 rather than 36247.
    You right! After I sent my thread, I realized that I did not answer that part of the question. 36247 is for the arterial side, not venous.

    Thanks,
    Jim

  5. #5
    Default
    Thank you for your input. You coders are always so helpful. I really do appreciate it.

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