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Tag Archives: Port

Help with chemo port coding op note

Posted on by
Can someone experienced with this type of coding please assist, as this is a whole new ball-game for me. MCR pat w/dx rectal cancer. I extracted the pertinent info & abbreviated from chart note to ease in assistance.
Summary:
* Access type: Left Other AVF/AVG.
* Subclavian vein: temporary dialysis catheter insertion.
Radiation Totals:
Total fluoro time: 1.0 min:sec
Technique:
——The R upper extremity and L upper extremity were prepped using Chloraprep R and L neck, chest to nipple line. Local/MAC sedation administered by CRNA services administered w/trained independent observer in attendance to monitor level of consciousness & physiological status. The subclavian vein was accessed in an antegrade fashion from L. After carefully reviewing the diagnostic fistulogram, it was decided to proceed w/intervention. Sheath was removed & upsized for 8-Fr sheath.
Intervention:
A catheter was placed over the wire in the subclavian vein. Temporary dialysis catheter insertion is positioned in the vessel. MedCOMP CT Implantable Port – REF #L MRDP80AMN 8 fr. 61cm MS Dignity CT Port Lot #: MNDM230 Exp. 07/31/2023 implanted into L chest via L Subclavian Vein.
The puncture site was closed using Incision site to L chest closed w/Dermabond.
Findings: Subclavian vein: normal.

I’m thinking 36561 and 77001 would be appropriate. Doctor listed 36299 (unlisted) for vascular injection.
Validation/correction would be appreciated.

Medical Billing and Coding Forum

mal-positioned chemo port with revision

Posted on by
Can someone take a look at this and offer some suggestions as to CPT code? Utilizing the index I find 36597 but this does not describe what was done, and no mention
of fluoroscopy. I’m totally puzzled and it probably is easier than I am making it.
Revision of l. internal jugular vein chemo port:
"local aneshtetic was infiltrated into skin overlying the port access pocket. Pocket was opened. The port was noted to be flipped w/hard plastic backing closest to skin.
Port was then secured in place in its intended position w/interrupted 3-0 Prolene suture. Port pocket was then closed w/running 4-0 Monocryl & Dermabond."

Medical Billing and Coding Forum

96523 Port Flush

Posted on by
This question has been brought up to me

"Saline flushes for PICC and Ports, is there a cap on how many you can charge for? Ex. PICC’s actually have NS 20ml flushes for each lumen and there are two lumens. Nursing is only charting on 1 lumen. Can we get more reimbursement for all 4, or no?"

My answer was that we can only charge cpt 96523 once. Is this correct? I cannot find any official guidelines on this.

Medical Billing and Coding Forum

Insert Port a Cath ICD

Posted on by
Hello,
I could use some help with an audit/education dispute.
When inserting a port-a-cath (cpt 36561) for chemo, what is the 1st listed dx? Z45.2 (2ndary code cancer) -or- cancer code (ex. C56.–, no Z code).

Education: Z45.1- Rationale: see index logic …Admission for…Fitting (of)…Port-a-cath = Z45.2. Fitting means installing, putting in, placing.
Auditing: Cancer code. Rationale: ICD guideline- Section I.C.21.c.7. "The aftercare Z code should not be used if treatment is directed at a current, acute disease. The diagnosis code is to be used in these cases.". the catheter is initially being inserted for treatment of the cancer if the patient had a problem later on with the catheter and it needed to be replaced or when chemo is done and the catheter needs to be removed you would use the Z code because at time the treatment is being directed at the catheter not the cancer.

Thanks for any advice.
Kim

Medical Billing and Coding Forum

Attempted Port Placement

Posted on by
Needle access into remnant of right and left IJ under ultrasound
guidance for attempted port placement. Informed consent was obtained from the patient for port placement.
Ultrasound evaluation however showed what appeared to be some remnant of
internal jugular veins bilaterally. Under ultrasound guidance first the
right, then the left remnant of the internal jugular vein was cannulated. A
wire, however, was unable to be placed centrally from either location.
Patient with history of previous neoplastic disease and radiation therapy.
Case was discussed with Dr. X’s nurse. Formal vascular ultrasound
evaluation may be useful for further evaluation of the patency or occlusion
of the central venous system. Access from the common femoral vein may be
attempted if no other suitable site is found/available
The patient tolerated this procedure will no evidence of immediate
complications.
Should I report 36561-53 or maybe 36011-50?
Thanks for any guidance :)

Medical Billing and Coding Forum

Port removal – help

Posted on by
Am I coding this correct?

36595-59
36590
36010
77001-59

1. Selective catheterization of SVC from right femoral vein
2. Endovascular retrieval of fractured infusaport from right atrium using en snare device
3. Intraoperative fluoroscopy
4.Removal of left subclavian infusaport

Using 21 gauge microstick needle the right femoral vein was cannulated. Guidewire was passed up into the IVC. The right groin was then dilated first with a 6-fench sheath and then i put a 11 french short sheath. I was able to pass the sheath up in to the SVC. I was able to pass the En snare device in attempt to snare the catheter which was in the distal SVC and the distal tip of the catheter appeared to be against the sidewall and I could not snare the tip of the catheter. At this time, I used multiple oblique views as well to help with visualization.

At this time, I decided then to try gooseneck catheter. A 25mm gooseneck catheter was then deployed, but the sheath was only 55cm and I could barely deploy the tip of the snare right at the level of the catheter, but I could not snare it.

I then placed the En snare device and finally was able to snare the distal end approximately 2-3 cm from the catheter. The snare catheter was then easily pulled down out of the heart in to the IVC into the right iliac vein. After putting tension on snare device, I was able to pull the sheath and complete catheter out under fluoroscopic guidance.The entire embolized catheter was removed and this was inspected and was later sent to pathology for gross only.

At this time, attention was then directed removing the patient’s left chest infusaport itself. An incision was made with a 11-blade scalpel and then electrocautery was used to dissect down to the port itself. The port was freed up. I then removed the entire catheter under fluoroscopy and the wounds were irrigated out.

Medical Billing and Coding Forum

broken port a cath retrieval via heart cath

Posted on by
One of my cardiologists performed a heart cath (via the subclavian and the groin) in order to retrieve a broken piece of a port-a-cath that had floated into the atrium and then lodged in the ventricle. We have never had to code this procedure before; and I am looking at 37197. He states that he had go through both locations simultaneously to guide the piece out of the ventricle and out of the body. Any help would be greatly appreciated!
Thanks

Medical Billing and Coding Forum

CPT CODE for Drainage of ascites through a peritoneal port

Posted on by
Can anyone give us direction on which CPT code to use for a patient who comes in with an existing peritoneal port for drainage of ascites. This is the note:

Pt was placed in bedroom and positioned. Vitals taken. Site draped and was cleaned with iodine, alcohol and chlorhexidine. Peritoneal
port was accessed aseptically with no issues. Three liters removed via phlebotomy bottles with no issues. Vitals continuously
assessed. Pt deaccessed and observed for thirty minutes.

Medical Billing and Coding Forum