thrombectomy

Can someone please help me with codes for this? I have:

36005/75820 for the venogram,

37187 for the aspiration thrombectomy, and

35476/75978 for the balloon angioplasty.

I also have 36584 for the PICC replacement.

Am I close? Thanks for all suggestions!

PRE-PROCEDURE DIAGNOSIS:

Right axillosubclavian vein thrombosis, sepsis

PROCEDURES PERFORMED:

RIGHT UPPER EXTREMITY CENTRAL VENOGRAM, RIGHT AXILLOSUBCLAVIAN VEIN

CATHETER DIRECTED THROMBOLYSIS, BALLOON ANGIOPLASTY, ASPIRATION

THROMBECTOMY, RIGHT INNOMINATE VEIN BALLOON ANGIOPLASTY, RIGHT CEPHALIC

VEIN SINGLE LUMEN PICC LINE EXCHANGED FOR DOUBLE-LUMEN PICC LINE.

IMAGING MODALITY UTILIZED:

Ultrasound and fluoroscopy

ANESTHESIA: Local.

ACCESS SITE:

Right basilic vein

CATHETER POSITION:

Right axillary vein, subclavian vein, SVC

TECHNIQUE: Skin overlying the right upper extremity inclusive of the right cephalic vein PICC line was sterilely prepped and draped in standard fashion.

Preprocedure antibiotics were administered. Under ultrasound guidance, the

above elbow basilic vein was accessed. A 7 French sheath was inserted.

Limited central venogram was performed, which demonstrates filling defects

and subtotal occlusive thrombosis of the right axillosubclavian vein.

There is a right innominate vein stenosis. There is a right cephalic vein

single-lumen PICC line with tip overlying the distal SVC.

The 7 French sheath was advanced into the axillosubclavian vein thrombus

over a 0.035 inch Bentson guidewire. Aspiration thrombectomy was conducted

initially. Heparin was administered. Thrombus was recovered and submitted

for culture analysis. Subsequently, a 5 French/10 cm infusion length

catheter was positioned within the axial subclavian thrombosed segment. A

total of 8 mg of TPA were administered using pulse spray technique. 8

milligrams were administered using split dose (4 mg x 2). Subsequently,

the axillosubclavian vein was further treated with balloon maceration using

an 8 mm balloon. The right innominate vein was treated with balloon

angioplasty to facilitate outflow using 8mm and 10 mm balloons. The

axillosubclavian vein segment was further treated with aspiration

thrombectomy, and balloon maceration using a larger size 10 mm balloon.

The right upper extremity cephalic vein PICC line was subsequently

exchanged over a 0.018 inch angled gold-tip Glidewire for a new 5 French

double-lumen PICC line. The cut length is 51 cm, the external length is 1

cm. The PICC line was secured to the skin and sterile dressing was

applied. The basilic vein access site was removed and compression

applied.

FINDINGS:

Limited right upper extremity central venogram demonstrates thrombotic

occlusion of the right axillosubclavian vein. High-grade right innominate

vein stenosis. SVC patent. Peripheral venous system not evaluated in

attempt to minimize contrast load in this patient with compromised renal

function. As described above, the axillosubclavian vein thrombus was

sampled for cultures, and treated with single stage thrombolysis, balloon

angioplasty, and aspiration thrombectomy. Completion study demonstrates

restored patency through the axillosubclavian vein with an element of

residual, possibly chronic wall-adherent thrombus. Given the presence of

infection, and lack of significant right upper extremity arm swelling.

Further adjunct methods such as stent placement were not performed.

As described above, the right cephalic vein PICC line was exchanged and

upsized for a 5 French double-lumen PICC line. Tip was positioned in the

distal SVC.

THERE IS A HIGH-GRADE RIGHT

INNOMINATE VEIN STENOSIS. AS DESCRIBED IN DETAIL ABOVE, AXILLOSUBCLAVIAN

VEIN THROMBOSIS WAS SAMPLED FOR CULTURE GIVEN THE CONCERN FOR SEPSIS.

SUBSEQUENT ATTEMPTS AT RESTORATION OF VEIN PATENCY WERE PERFORMED USING

CATHETER DIRECTED THROMBOLYSIS, BALLOON MACERATION ANGIOPLASTY AND

ASPIRATION THROMBECTOMY. THERE IS RESTORATION OF PROGRADE FLOW, HOWEVER

THERE IS RESIDUAL THROMBUS WITHIN THE AXILLOSUBCLAVIAN VEIN, THIS COULD

REFLECT CHRONIC WALL ADHERENT THROMBUS. GIVEN THE PRESENCE OF SEPSIS, AND

LACK OF SIGNIFICANT RIGHT UPPER EXTREMITY ARM SWELLING, FURTHER ADJUVANT

METHODS SUCH AS STENT INSERTION WERE NOT PERFORMED.

RIGHT UPPER EXTREMITY PICC LINE EXCHANGED AND UPSIZED FOR A 5 FRENCH

DOUBLE-LUMEN PICC LINE AS DESCRIBED.

thrombectomy