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portal venography

  1. Default portal venography
    Medical Coding Books
    Can anyone please confirm my codes for the below procedure,

    37187
    37201-59
    37205
    36011
    75896-26
    75960-26
    75885-26

    Using real time ultrasound guidance, access was
    obtained into the a peripheral right portal vein branch using a 21
    gauge Chiba needle. A 0.018 inch guide wire was advanced through
    the needle into the portal vein. The needle was removed and
    exchange for a Neff coaxial dilator. A seven French vascular
    sheath was then placed extending into the portal vein. Portal
    venography was performed. A 6 French MPA guiding catheter and a
    coaxially.-placed 4 French Berenstein catheter were advanced
    through the sheath and guided to the site of occlusion. A
    rock-hard occlusion of the main portal was then crossed using a
    hydrophilic guidewire and the catheter advanced into the superior
    mesenteric vein. The catheter was then exchanged for a 5 French
    sizing pigtail catheter which was positioned within the midportion
    of the superior mesenteric vein. A superior mesenteric/portal
    venogram was performed.

    After exchanging over a stiff guide wire, a 12 mm x 60 mm
    self-expanding Smart stent was deployed across the main portal
    vein occlusion extending into the right portal vein. The stent
    was dilated using a 10 mm x 4 cm angioplasty balloon. Repeat
    portal venography was performed. A 6 French Possis mechanical
    thrombectomy device was then deployed within the main and right
    portal vein. Approximately 200 cc of fluid was aspirated. Repeat
    venography was performed. A multi-sidehole infusion catheter with
    a 10 cm long infusion length was then deployed extending from the
    upper superior mesenteric vein through the right portal vein. The
    right portal veins was then laced with 4 cc of alteplase. The
    patient was started on continuous infusion of alteplase through
    the infusion catheter at a total rate of 0.5 mg per hour. The
    catheter and sheath were sutured into place and a sterile dressing
    applied to the site.

    Findings: Portal venography demonstrates patency of the superior
    mesenteric and splenic veins. Abrupt occlusion of the main portal
    vein beyond the junction of the superior mesenteric and splenic
    veins is noted. The occlusion extends for approximately 2.5-3 cm
    in length. Outflow is via tortuous, enlarged collateral vessels
    within the upper abdomen. A splenorenal shunt is identified.
    Partially obstructing intraluminal thrombus is identified within
    the right and left portal veins as well as in several right portal
    vein branches. The stent was deployed extending from junction of
    the splenic and superior mesenteric veins, across the main portal
    vein and extending into the right portal vein. Following stent
    deployment and dilatation, poor flow is identified within the
    distal branches secondary to intraluminal thrombus. Mechanical
    thrombectomy using a 6 French Possis thrombectomy device was then
    performed with restoration of flow within the portal veins.
    However, intraluminal thrombosis was still identified within
    several branches. The patient was started on continuous infusion
    of alteplase into the portal vein as described above.

    Conclusion: Portal venogram demonstrating 2.5-3 cm long occlusion of the main
    portal from its origin and extending to the right and left portal
    veins. Partially-obstructing thrombus is identified within the
    right and left portal veins, as identified on previous CT scan of
    August 3. Outflow from the superior mesenteric and splenic veins
    is via enlarged collateral vessels within the upper abdomen. A
    prominent splenorenal shunt is identified.

    Successful deployment and dilatation of 12 mm x 6 cm
    self-expanding Smart stent across the portal venous occlusion
    extending into the right portal with good cosmetic result as
    described above.

    Mechanical thrombectomy of portal vein thrombus was performed
    using a 6 French Possis thrombectomy device as described above.
    The patient was started on continuous thrombolytic infusion via
    multi-sidehole infusion catheter deployed across the main and
    right portal veins. The patient is to continue infusion overnight
    while being observed in the intensive care unit and is to return
    tomorrow for followup examination.
    Prabha CPC

  2. #2
    Location
    Birmingham, Alabama
    Posts
    889
    Default
    Quote Originally Posted by prabha View Post
    Can anyone please confirm my codes for the below procedure,

    37187
    37201-59
    37205
    36011
    75896-26
    75960-26
    75885-26

    Using real time ultrasound guidance, access was
    obtained into the a peripheral right portal vein branch using a 21
    gauge Chiba needle. A 0.018 inch guide wire was advanced through
    the needle into the portal vein. The needle was removed and
    exchange for a Neff coaxial dilator. A seven French vascular
    sheath was then placed extending into the portal vein. Portal
    venography was performed. A 6 French MPA guiding catheter and a
    coaxially.-placed 4 French Berenstein catheter were advanced
    through the sheath and guided to the site of occlusion. A
    rock-hard occlusion of the main portal was then crossed using a
    hydrophilic guidewire and the catheter advanced into the superior
    mesenteric vein. The catheter was then exchanged for a 5 French
    sizing pigtail catheter which was positioned within the midportion
    of the superior mesenteric vein. A superior mesenteric/portal
    venogram was performed.

    After exchanging over a stiff guide wire, a 12 mm x 60 mm
    self-expanding Smart stent was deployed across the main portal
    vein occlusion extending into the right portal vein. The stent
    was dilated using a 10 mm x 4 cm angioplasty balloon. Repeat
    portal venography was performed. A 6 French Possis mechanical
    thrombectomy device was then deployed within the main and right
    portal vein. Approximately 200 cc of fluid was aspirated. Repeat
    venography was performed. A multi-sidehole infusion catheter with
    a 10 cm long infusion length was then deployed extending from the
    upper superior mesenteric vein through the right portal vein. The
    right portal veins was then laced with 4 cc of alteplase. The
    patient was started on continuous infusion of alteplase through
    the infusion catheter at a total rate of 0.5 mg per hour. The
    catheter and sheath were sutured into place and a sterile dressing
    applied to the site.

    Findings: Portal venography demonstrates patency of the superior
    mesenteric and splenic veins. Abrupt occlusion of the main portal
    vein beyond the junction of the superior mesenteric and splenic
    veins is noted. The occlusion extends for approximately 2.5-3 cm
    in length. Outflow is via tortuous, enlarged collateral vessels
    within the upper abdomen. A splenorenal shunt is identified.
    Partially obstructing intraluminal thrombus is identified within
    the right and left portal veins as well as in several right portal
    vein branches. The stent was deployed extending from junction of
    the splenic and superior mesenteric veins, across the main portal
    vein and extending into the right portal vein. Following stent
    deployment and dilatation, poor flow is identified within the
    distal branches secondary to intraluminal thrombus. Mechanical
    thrombectomy using a 6 French Possis thrombectomy device was then
    performed with restoration of flow within the portal veins.
    However, intraluminal thrombosis was still identified within
    several branches. The patient was started on continuous infusion
    of alteplase into the portal vein as described above.

    Conclusion: Portal venogram demonstrating 2.5-3 cm long occlusion of the main
    portal from its origin and extending to the right and left portal
    veins. Partially-obstructing thrombus is identified within the
    right and left portal veins, as identified on previous CT scan of
    August 3. Outflow from the superior mesenteric and splenic veins
    is via enlarged collateral vessels within the upper abdomen. A
    prominent splenorenal shunt is identified.

    Successful deployment and dilatation of 12 mm x 6 cm
    self-expanding Smart stent across the portal venous occlusion
    extending into the right portal with good cosmetic result as
    described above.

    Mechanical thrombectomy of portal vein thrombus was performed
    using a 6 French Possis thrombectomy device as described above.
    The patient was started on continuous thrombolytic infusion via
    multi-sidehole infusion catheter deployed across the main and
    right portal veins. The patient is to continue infusion overnight
    while being observed in the intensive care unit and is to return
    tomorrow for followup examination.
    I agree.
    Danny L. Peoples
    CIRCC,CPC

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