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Central venous acess

  1. Default Central venous acess
    Medical Coding Books
    How to code this senario.
    Preliminary ultrasound demonstrates irregularity of the left
    internal and external jugular veins. The left neck was then
    prepped and draped in the usual sterile manner and locally
    anesthetized with two percent lidocaine. Under ultrasound
    guidance, the left internal jugular vein was accessed with a
    micropuncture set.
    The microwire would not advance below the
    level of the clavicle. Subsequently, limited venography through
    the needle was performed, demonstrating an occluded left internal
    jugular vein with abnormal, tortuous collateral vessels at the
    base of the left neck.

    Subsequently, the left external jugular vein was punctured with a
    21-gauge needle A permanent recording was created for the
    patient's record. The
    microwire would not advance through the

    needle. Subsequently, limited venography was performed,
    demonstrating an occluded left external jugular vein. The left
    neck access was then aborted.

    Limited ultrasound of the right common femoral vein was then
    performed, demonstrating a widely patent and freely compressible
    vein. Subsequently, the right groin was prepped and draped in
    usual sterile fashion. 1% lidocaine was administered for local
    anesthesia. Under real-time sonographic guidance, a 21-gauge
    needle was advanced into the right common femoral vein
    . A
    sonographic recording was created for the patient's record.
    Exchange was made for a micropuncture set. The tract was then
    dilated over a guidewire, and a 24 cm long Schon XL non-tunneled
    dialysis catheter was placed, catheter tip in the inferior vena
    cava. Good bidirectional flow was noted from both lumens, which
    were locked with heparin solution. The catheter was sutured in
    place with prolene and a sterile dressing applied. The patient
    tolerated the procedure well, and left the department in stable

  2. Default suggestion
    Hi mindys please give your suggestion for the above senario

    Shirley CPC, CPC-H

  3. #3
    I was looking at 75860 for the jugular venograms. (possibly add a 52 mod since it says limited venogram??)
    36005-59x2 for both punctures (internal jug. and external jug.)
    76937 for the US recording and 36556 for the central line.

    I'm not sure what your dx code is for the cath. placement, but use that for the central line and the occlusion of the veins for the venography.

    Those are my thoughts

  4. Default IJV(internal jugular vein)
    For IJV puncture 36010 should be used , It is given in Med lern (IR manul from AMA)

  5. #5
    an ipsilateral internal jugular vein puncture is 36005 per the Interventional Radiology Coder. These were direct punctures of each vein.

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