• Register to Access the Free Forums and 3 Free CEUs!

    To view the content for the 3 free CEUs, please sign up today.

    CLICK HERE TO REGISTER
  • Missing Access To A Course, Blitz or Exam? Have Technical Issues? Open a Help Desk Ticket
    Please Do Not Post in the Community About Access or Technical Issues
    CCO Business Hours for Help Desk and Coaching: Mon-Fri 9am-4pm Eastern

Resolved Help coding IR please

Status
Not open for further replies.

DoraV_64753

New member
Hello,

I am a new recently certified coder. Can someone please help me code the following procedure. So far I have
36902,36908,36012 37248 ? but I’m really not sure.
any help is greatly appreciate. thank you!



FINDINGS & PROCEDURE: After informed consent and under sterile conditions the right forearm fistula was accessed in the venous direction and a 5 French sheath was established. Using real time ultrasound guidance, access was obtained to the right femoral vein and a 7 French sheath was established. A fistulagram was performed revealing a patent forearm cephalic vein stenosis. A 70% axillary vein stenosis was noted. Centrally a 90% SCV and 100% complete central vein occlusion is noted of the right BCV. In a retrograde manner an inflow arteriogram was performed revealing a modest inflow stenosis. A wire directed selective catheter was required to traverse the outflow lesion. An 8mm PTA was performed of the stenosis of the axillary vein. An 8mm PTA was performed of the subclavian vein stenosis. A Glidewire and selective catheter was advanced through the CFV, EIV, CIV, IVC, RA and SVC to the right BCV. A dedicated SVCgram was performed which confirmed a total occlusion and collateral veins maintain patency. Thrombus was manually aspirated and mechanically cleared from the right BCV. Several attempts were made to traverse the complete occlusion with ultimate success using a stiff Terumo glid and a Glidecatheter. The central vein occlusion was recanalized with serial PTA of 4mm, 8mm then 10mm PTA. A 14x40mm stent was ultimately deployed and then post-dilated to 10mm to restore in-line flow the fistula circuit. A good thrill was noted clinically and follow-up fistulagram and venogram demonstrated wide patency. Hemostasis was obtained. IMPRESSION/PLAN: Right forearm fistulagram, venogram and arteriogram with successful angioplasty, 14x40mm stent placement and central vein recanalization with venous thrombectomy.
 
Taking a look and will get back with you soon. Also going to check in with Stacie who is an CIRCC educator.


FINDINGS & PROCEDURE: After informed consent and under sterile conditions the right forearm fistula was accessed in the venous direction and a 5 French sheath was established. Using real time ultrasound guidance, access was obtained to the right femoral vein and a 7 French sheath was established. A fistulagram was performed revealing a patent forearm cephalic vein stenosis. A 70% axillary vein stenosis was noted. Centrally a 90% SCV and 100% complete central vein occlusion is noted of the right BCV. In a retrograde manner an inflow arteriogram was performed revealing a modest inflow stenosis. A wire directed selective catheter was required to traverse the outflow lesion. An 8mm PTA was performed of the stenosis of the axillary vein. An 8mm PTA was performed of the subclavian vein stenosis. A Glidewire and selective catheter was advanced through the CFV, EIV, CIV, IVC, RA and SVC to the right BCV. A dedicated SVCgram was performed which confirmed a total occlusion and collateral veins maintain patency. Thrombus was manually aspirated and mechanically cleared from the right BCV. Several attempts were made to traverse the complete occlusion with ultimate success using a stiff Terumo glid and a Glidecatheter. The central vein occlusion was recanalized with serial PTA of 4mm, 8mm then 10mm PTA. A 14x40mm stent was ultimately deployed and then post-dilated to 10mm to restore in-line flow the fistula circuit. A good thrill was noted clinically and follow-up fistulagram and venogram demonstrated wide patency. Hemostasis was obtained.

IMPRESSION/PLAN: Right forearm fistulagram, venogram and arteriogram with successful angioplasty, 14x40mm stent placement and central vein recanalization with venous thrombectomy.

36902,
If stenosis remains, a fine mesh/wire stent is delivered to the area of stenosis through the working channel of the vascular catheter (36903). The stent expands, placing pressure on the walls of the blood vessel to keep it open. The catheter is removed and a purse string suture may be placed to control bleeding before the vascular sheath is removed. Stent placement in the peripheral dialysis segment includes the angioplasty.

36908, Transluminal balloon angioplasty (36907) is performed when stenosis of the central vein(s) is identified. A balloon tipped catheter is inserted over the guidewire through the stenosed area. The balloon is inflated with dilute radiopaque contrast and visualized with fluoroscopy. At the end of the prescribed time, the balloon is deflated and the catheter is removed. A vascular catheter with a working channel is then threaded over the guidewire and angiography is repeated to evaluate for resistant or residual stenosis. If stenosis remains, a fine mesh/wire stent is delivered to the area of stenosis in the central venous segment through the working channel of the vascular catheter (36908). The stent expands, placing pressure on the walls of the blood vessel to keep it open. The catheter is removed and a purse string suture may be placed to control bleeding before the vascular sheath is removed. Stent placement in the central dialysis segment includes the angioplasty, all imagining, and radiological supervision and interpretation.

36012 - Selective catheter placement, venous system; second order, or more selective, branch (eg, left adrenal vein, petrosal sinus)

A selective venous catheterization procedure is performed. Common access veins include the brachial and cephalic veins. A small incision is made over the planned puncture site and an introducer sheath placed in the vein. From the brachial or cephalic vein, a guidewire is advanced through the access vein and into the superior vena cava. From there, the catheter is advanced into a venous branch off the superior vena cava, such as the jugular vein, or the catheter may be advanced through the right atrium and into the inferior vena cava and then into a branch off the inferior vena cava, such as the hepatic or renal vein. The catheter may remain in the first-order branch, which is any vein that drains directly into the vena cava, or the catheter may be advanced into a second-order or more selective branch, such as the petrosal sinus or left adrenal vein. Injection of medication and/or radiopaque contrast is performed as needed. Use 36011 for selective catheter placement in a first-order vein branch and 36012 for a second-order or more selective vein branch.

37248 - Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein

Code 37248 reports balloon angioplasty on the initial vein (except in the dialysis circuit), either open or percutaneous, and includes all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein. Code 37249 reports each additional vein.
 
Thank you very much!
I am finding this specialty challenging. if Stacie and/or you can recommend any CIRCC education courses or training. It would much appreciated.
 
You are correct. This is an area that take a lot of practice. I would go to Stacie to get the best CIRCC training out there. Her answer was:
Only 2 codes –
36905 (thrombectomy of dialysis circuit w/ PTA) and 36908 (stent of central segment).

Connect with her. I know she can get you trained and feeling more confident.
Here is Stacie's information.
Stacie L. Buck, RHIA, CCS-P, RCC, RCCIR, CIRCC

President & Senior Consultant, RadRx
Email sbuck@radrx.com
Phone (772) 287-8849
Website www.radrx.com
Visit our online store for coding resources: www.shop.radrx.com
 
Status
Not open for further replies.
Back
Top