Language Services Used or Declined: Not Applicable – Interpreter Services not required.

Event Note:
· .
Consulted by Dr Silver from pediatric hematology to assist with vascular access in this 17 year old male with epidermolysis bullosa and chronic iron defiency anemia for planned labwork and iv iron infusion. patient registered at hematology infusion center and transported to ED for ultrasound guided phlebotomy and IV placement.

patient accompanied by mother, home nurse and Dr Silverman from peds hematology

Procedure Note:
Procedure: intravenous line placement
Indication: chronic difficult vascular access, chronic iron defiency anemia, for scheduled phlebotomy and IV access to assist with iron infusion
22 gauge 1.5 inch needle placed under sonographic guidance in LUE vein
good blood return, flushed easily with normal saline with sonographic confirmation into vein – no resistance. Secured with gauze and paper tape as pre patient’s skin care protocol.

Labs and clinical care handed off to Dr Silver to transport patient back to infusion center for his iron infusion.

Time Spent: 90 minutes

dr Fox MD

What CPT code would you use ? Thanks