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Thread: TIPS eval

  1. #1
    Join Date
    Apr 2007
    Tacoma, WA

    Default TIPS eval

    AAPC: Back to School
    Thoughts on coding for this? I coded 36011, 36481, 75885 (since it doesn't appear hepatic venography was performed).

    EXAM DESCRIPTION: Transjugular intrahepatic portosystemic shunt

    INDICATION: hepatitis C and endstage liverdisease, had a transjugular intrahepatic portosystemic shunt placed in February, revised in September. Followup ultrasound showed elevated velocities in the mid portion of the shunt, concerning for possible stenosis.Angiography requested.

    1. Ultrasound-guided access of the left internal jugular vein.
    2. Placement of a 6-French sheath into the right atrium with
    hemodynamic pressure monitoring here.
    3. Cannulation of the portosystemic shunt with placement of a pigtail
    catheter in the portal vein.
    4. Hemodynamic pressure monitoring in the portal vein.
    5. Portal and shunt venogram.

    After procedure, alternatives, risks, and questions (PARQ) conference
    was held and informed consent obtained, the patient was placed supine
    on the angiography table and the left lower neck prepped and draped
    in sterile fashion. Skin and subcutaneous tissues were anesthetized
    with 1% buffered lidocaine. Under ultrasound guidance, the left
    internal jugular vein was accessed with the micropuncture set and a
    0.035-inch wire passed to the inferior vena cava (IVC). A 6-French
    sheath was placed over the wire with tip in the right atrium.
    Hemodynamic pressure monitoring was performed here.
    A 5-French Levin catheter and wire were passed through the sheath and
    used to cannulate the right hepatic vein and transjugular
    intrahepatic portosystemic shunt (TIPS) shunt with wire placed
    distally in the portal vein. The catheter was exchanged for a
    5-French pigtail catheter. With this in the portal vein, hemodynamic
    pressure monitoring was performed. This was followed by contrast
    injection for portal and shunt venogram.
    The catheter was removed over a wire. The patient was transferred to
    his bed and the sheath removed and manual pressure held until
    hemostasis achieved. Sterile bandage was applied. The patient
    tolerated the procedure well without immediate complications and was
    transferred back to the recovery area in stable condition for

    Right atrial pressure was 5 mmHg and portal vein pressure 15 mmHg,
    for a gradient of 10 mmHg. Main portal vein is normal in caliber. Two
    overlapping stents are in place for the portosystemic shunt from the
    main portal vein to the right hepatic vein. The hepatic vein end is
    approximately 3 cm from the right atrium. There is brisk flow
    throughout the main portal vein into the shunt, right hepatic vein,
    and right atrium. There is no evidence of stenosis anywhere within
    the shunt. No antegrade flow is visible in distal portal vein
    branches. Clips in the right upper quadrant are compatible with
    1. Widely patent intrahepatic portosystemic shunt with brisk flow and
    no evidence of stenosis.
    2. Portal vein to right atrium pressure gradient of 10 mmHg.
    Stacy Gregory, CPC, CCC, RCC

  2. #2


    I agree with your codes

  3. #3
    Join Date
    Apr 2007


    How to ICD-9 code for TIPS evaluation?
    Catrina Jacobs, RCC, CPC

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