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Tunneled cath exchange

  1. #1
    Default Tunneled cath exchange
    Medical Coding Books
    Hello,

    Maybe I am reading too much into this report as it seems there's a lot of info for just a simple tunneled CV cath replacement. It's been a while since I've coded one, but I recall the ballooning of the subcutaneous tract was included in the change. I coded this as 36581, 77001. Thoughts? Thanks!

    PROCEDURE: REPLACEMENT TUNNELED CV CATH
    INDICATION: Patient with non-functioning Permcath. The patient
    states the Permcath was placed approximately 5 years ago. Upon
    inspection, the cuff is out of the skin.

    PROCEDURE PERFORMED:
    1. Removal of a tunnel dialysis catheter over a wire.
    2. Superior vena cava venogram.
    3. Balloon angioplasty of the catheter entry site at the right
    internal jugular vein.
    4. Placement of a new 23-cm, tip-to-cuff, tunnel dialysis line with a
    Dacron cuff.
    5. IV conscious sedation.

    PROCEDURE DESCRIPTION
    Preprocedure evaluation confirmed that the patient was an appropriate
    candidate for conscious sedation. Vital signs, pulse oximetry, and
    response to verbal commands were monitored and recorded by the nurse
    throughout the procedure and the recovery period. All medications for
    conscious sedation including the dose administered were placed in the
    medical record. The patient returned to baseline neurologic and
    physiologic status prior to leaving the department. No immediate
    sedation-related complications were noted.
    Informed written consent was obtained from the patient after
    discussion of the risks, benefits, and alternatives to the procedure.
    The patient expressed full understanding and agreed to proceed
    forward.
    The patient was placed supine on the angiographic table. The exiting
    catheter and right chest were prepped and draped in normal sterile
    fashion. Two stiff glidewires were advanced through the lumen of the
    catheter into the inferior vena cava after the heparin had been
    withdrawn. The catheter was removed without difficulty. A new 19-cm,
    tip-to-cuff catheter was inserted. The tip of the line is within the
    superior vena cava. The tube would not aspirate or flush, therefore
    the tube was removed over the stiff glidewires. A 23-cm, tip-to-cuff
    catheter was then inserted. The catheter had difficulty advancing.
    With the catheter in the superior vena cava, injection of contrast
    was performed to evaluate for stenosis. The superior vena cava is
    widely patent. The catheter was then attempted to be re-advanced
    without success. Following, the catheter was withdrawn and balloon
    angioplasty was performed throughout the subcutaneous tract as well
    as the venotomy site with a 4 mm balloon. The catheter was then
    re-advanced without success. Following, with the catheter in the
    superior vena cava, the wire was withdrawn and 2 stiff Amplatz wires
    were then advanced into the inferior vena cava. Eventually, the
    catheter was then placed with tip in the right atrium. The line is
    intact without evidence of disconnect or kink. The line flushes and
    aspirates appropriately.
    The line was secured to the skin using 2-0 prolene suture. The line
    was blocked with heparin per the manufacturer's protocol.
    The patient received 1 g Ancef and 50 mcg fentanyl IV during the
    procedure. A total of 20 mL of contrast was injected into the
    superior vena cava.

    CONCLUSION
    1. Successful exchange of a dual-lumen dialysis catheter with a
    Dacron cuff. A 23-cm, tip-to-cuff, 15.5-French, dual-lumen catheter
    was placed with tip in the right atrium. The line flushes and
    aspirates appropriately.
    2. Superior vena cavogram was performed demonstrating a widely patent superior vena cava.
    Stacy Gregory, CPC, CCC, RCC

  2. #2
    Default
    Anyone have any ideas on this one? Thanks!
    Stacy Gregory, CPC, CCC, RCC

  3. #3
    Location
    Birmingham, Alabama
    Posts
    890
    Default
    Quote Originally Posted by stgregor View Post
    Hello,

    Maybe I am reading too much into this report as it seems there's a lot of info for just a simple tunneled CV cath replacement. It's been a while since I've coded one, but I recall the ballooning of the subcutaneous tract was included in the change. I coded this as 36581, 77001. Thoughts? Thanks!

    PROCEDURE: REPLACEMENT TUNNELED CV CATH
    INDICATION: Patient with non-functioning Permcath. The patient
    states the Permcath was placed approximately 5 years ago. Upon
    inspection, the cuff is out of the skin.

    PROCEDURE PERFORMED:
    1. Removal of a tunnel dialysis catheter over a wire.
    2. Superior vena cava venogram.
    3. Balloon angioplasty of the catheter entry site at the right
    internal jugular vein.
    4. Placement of a new 23-cm, tip-to-cuff, tunnel dialysis line with a
    Dacron cuff.
    5. IV conscious sedation.

    PROCEDURE DESCRIPTION
    Preprocedure evaluation confirmed that the patient was an appropriate
    candidate for conscious sedation. Vital signs, pulse oximetry, and
    response to verbal commands were monitored and recorded by the nurse
    throughout the procedure and the recovery period. All medications for
    conscious sedation including the dose administered were placed in the
    medical record. The patient returned to baseline neurologic and
    physiologic status prior to leaving the department. No immediate
    sedation-related complications were noted.
    Informed written consent was obtained from the patient after
    discussion of the risks, benefits, and alternatives to the procedure.
    The patient expressed full understanding and agreed to proceed
    forward.
    The patient was placed supine on the angiographic table. The exiting
    catheter and right chest were prepped and draped in normal sterile
    fashion. Two stiff glidewires were advanced through the lumen of the
    catheter into the inferior vena cava after the heparin had been
    withdrawn. The catheter was removed without difficulty. A new 19-cm,
    tip-to-cuff catheter was inserted. The tip of the line is within the
    superior vena cava. The tube would not aspirate or flush, therefore
    the tube was removed over the stiff glidewires. A 23-cm, tip-to-cuff
    catheter was then inserted. The catheter had difficulty advancing.
    With the catheter in the superior vena cava, injection of contrast
    was performed to evaluate for stenosis. The superior vena cava is
    widely patent. The catheter was then attempted to be re-advanced
    without success. Following, the catheter was withdrawn and balloon
    angioplasty was performed throughout the subcutaneous tract as well
    as the venotomy site with a 4 mm balloon. The catheter was then
    re-advanced without success. Following, with the catheter in the
    superior vena cava, the wire was withdrawn and 2 stiff Amplatz wires
    were then advanced into the inferior vena cava. Eventually, the
    catheter was then placed with tip in the right atrium. The line is
    intact without evidence of disconnect or kink. The line flushes and
    aspirates appropriately.
    The line was secured to the skin using 2-0 prolene suture. The line
    was blocked with heparin per the manufacturer's protocol.
    The patient received 1 g Ancef and 50 mcg fentanyl IV during the
    procedure. A total of 20 mL of contrast was injected into the
    superior vena cava.

    CONCLUSION
    1. Successful exchange of a dual-lumen dialysis catheter with a
    Dacron cuff. A 23-cm, tip-to-cuff, 15.5-French, dual-lumen catheter
    was placed with tip in the right atrium. The line flushes and
    aspirates appropriately.
    2. Superior vena cavogram was performed demonstrating a widely patent superior vena cava.
    I agree with your code selection.
    HTH
    Danny L. Peoples
    CIRCC,CPC

  4. Red face Your codes r right, angioplasty performed for the tract purpose is not billed separte
    Quote Originally Posted by stgregor View Post
    Hello,

    Maybe I am reading too much into this report as it seems there's a lot of info for just a simple tunneled CV cath replacement. It's been a while since I've coded one, but I recall the ballooning of the subcutaneous tract was included in the change. I coded this as 36581, 77001. Thoughts? Thanks!

    PROCEDURE: REPLACEMENT TUNNELED CV CATH
    INDICATION: Patient with non-functioning Permcath. The patient
    states the Permcath was placed approximately 5 years ago. Upon
    inspection, the cuff is out of the skin.

    PROCEDURE PERFORMED:
    1. Removal of a tunnel dialysis catheter over a wire.
    2. Superior vena cava venogram.
    3. Balloon angioplasty of the catheter entry site at the right
    internal jugular vein.
    4. Placement of a new 23-cm, tip-to-cuff, tunnel dialysis line with a
    Dacron cuff.
    5. IV conscious sedation.

    PROCEDURE DESCRIPTION
    Preprocedure evaluation confirmed that the patient was an appropriate
    candidate for conscious sedation. Vital signs, pulse oximetry, and
    response to verbal commands were monitored and recorded by the nurse
    throughout the procedure and the recovery period. All medications for
    conscious sedation including the dose administered were placed in the
    medical record. The patient returned to baseline neurologic and
    physiologic status prior to leaving the department. No immediate
    sedation-related complications were noted.
    Informed written consent was obtained from the patient after
    discussion of the risks, benefits, and alternatives to the procedure.
    The patient expressed full understanding and agreed to proceed
    forward.
    The patient was placed supine on the angiographic table. The exiting
    catheter and right chest were prepped and draped in normal sterile
    fashion. Two stiff glidewires were advanced through the lumen of the
    catheter into the inferior vena cava after the heparin had been
    withdrawn. The catheter was removed without difficulty. A new 19-cm,
    tip-to-cuff catheter was inserted. The tip of the line is within the
    superior vena cava. The tube would not aspirate or flush, therefore
    the tube was removed over the stiff glidewires. A 23-cm, tip-to-cuff
    catheter was then inserted. The catheter had difficulty advancing.
    With the catheter in the superior vena cava, injection of contrast
    was performed to evaluate for stenosis. The superior vena cava is
    widely patent. The catheter was then attempted to be re-advanced
    without success. Following, the catheter was withdrawn and balloon
    angioplasty was performed throughout the subcutaneous tract as well
    as the venotomy site with a 4 mm balloon. The catheter was then
    re-advanced without success. Following, with the catheter in the
    superior vena cava, the wire was withdrawn and 2 stiff Amplatz wires
    were then advanced into the inferior vena cava. Eventually, the
    catheter was then placed with tip in the right atrium. The line is
    intact without evidence of disconnect or kink. The line flushes and
    aspirates appropriately.
    The line was secured to the skin using 2-0 prolene suture. The line
    was blocked with heparin per the manufacturer's protocol.
    The patient received 1 g Ancef and 50 mcg fentanyl IV during the
    procedure. A total of 20 mL of contrast was injected into the
    superior vena cava.

    CONCLUSION
    1. Successful exchange of a dual-lumen dialysis catheter with a
    Dacron cuff. A 23-cm, tip-to-cuff, 15.5-French, dual-lumen catheter
    was placed with tip in the right atrium. The line flushes and
    aspirates appropriately.
    2. Superior vena cavogram was performed demonstrating a widely patent superior vena cava.

    Your codes r right, angioplasty performed for the tract purpose is not billed separately!

  5. #5
    Location
    Sarasota FL
    Posts
    1,073
    Default Tunneled cath exchange
    This thread is from 2011. I think the claim will have been submitted by now.
    It is worth looking at the dates in these threads.

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