Diana Posted Mon 24th of June, 2013 18:12:36 PM
PICC WAS PLACED AFTER EXTREMITY VENOGRAM, SVC GRAM, ANGIOPLASTY OF SUBCLAVIAN VEIN WITH EVENTUAL STENT PLACEMENT..
Using direct ultrasonographic visualization, the rt basilic vein was punctured just above the antecubital fossa with a 21-gauge needle, and a 0.018 guidewire was introduced into the rt basilic vein. Over the guidewire, the Cook micropuncture system was used to place a 5-French catheter into the rt basilic vein. The catheter and wire were then steered across the right basilic vein into the rt axillary vein. A rt axillary venogram and subclavian venogram were then performed. A superior venacavagram was also obtained.
There is no significant stenosis identified in the right axillary vein. There is 90% stenosis of the right subclavian vein. Multiple collateral vessels are seen to course over the right shoulder to bypass this area of severe stenosis.
An angled Glidewire was used to carefully traverse the high grade stenosis of the rt subclavian vein. After traversing the stenosis, a 10 mm diameter angioplasty balloon was placed across the stenosis, and balloon dilatation was performed. Post balloon dilatation, there is 50% residual stenosis at the angioplasty site. For this reason, a 12 mm diameter x 6 cm length nitinol stent was deployed across the stenosis and dilated to 10 mm in diameter using angioplasty balloon.
Over the guidewire, a 5-French double lumen PICC line was then placed into the superior vena cava. The tip of the PICC line was positioned at the cavoatrial junction. Both lumens of the PICC line were flushed with heparinized saline.
The PICC line was affixed to the skin with a fixation device provided in a kit.
SuperCoder Answered Tue 25th of June, 2013 19:31:34 PM
PICC isn’t bundled into any of those codes by CCI (but 36005 is bundled into 36569). Be sure to check a few items:
* 76937 requires permanent recording and reporting, so double check whether it applies here
* Instead of 75710, did you mean 75820 (venography)? And 75827 (as in the subject line) instead of 75728
Diana Posted Wed 26th of June, 2013 14:26:46 PM
The is a separate image recorded of the ultrasound guided access (76937).. Now, I realize that 3005 is bundled into ~36569~...so if the access is before the stent placement and venogram, I still cannot code it?
Also, yes you are correct I ment ~75820~ and ~75827~.
thanks for all your input...love Supercoder
SuperCoder Answered Thu 27th of June, 2013 00:25:34 AM
My Consulting Editor is looking up this query. She will respond soon.
SuperCoder Answered Wed 21st of August, 2013 21:46:29 PM
There appear to be differences of opinion on this, but many experts advise that because 36005 is a catheter placement code, it is rolled into the payment for the interventional services performed at the same session, and you should not report it separately.