Question

LOCATION: Inpatient, Hospital

PATIENT: Tim Luther

ATTENDING/ADMIT PHYSICIAN: Frank Gaul, MD

SURGEON: David Barton, MD

PREOPERATIVE DIAGNOSIS: Fluid overload state, no urine output, acute renal failure. POSTOPERATIVE DIAGNOSIS: Fluid overload state, no urine output, acute renal failure. PROCEDURE PERFORMED: Temporary dialysis catheter placement.

PROCEDURE: This 77-year-old patient was brought to the emergency room. The right femoral vein was selected. This was tried with the left IJ vein earlier without success. I reserved the right IJ for a central line that will be placed by interventional radiology in the morning. The right femoral vein was localized using ultrasound. (The ultrasound is not a reportable service.) The area was prepped in the usual fashion. One-percent lidocaine was used for local anesthesia. The right femoral vein was accessed under real-time ultrasound guidance without difficulty. The guidewire was advanced smoothly. The hook needle was taken out. The right femoral vein was dilated. An 11.5 French 16-cm temporary dialysis catheter with a straight extension was advanced to the iliac vein through the right femoral vein over the guidewire using the Seldinger technique without difficulty. Both ports had good venous blood return. Both ports were flushed with saline and heparin. The catheter was secured to the skin. The patient tolerated the procedure very well without immediate complication. Dialysis will be done semi-urgently.

8. Was the catheter tunneled or non-tunneled?

9. Does the age of the patient affect code selection?

10. Was a port and/or pump inserted?

11. Does the type of radiologic guidance affect the radiology code selection?

Answer 1

8) Tunneled catheter : A  tunneled catheter is used for temporary dialysis and allows  long term access to the vein.It is placed under the skin in a vein.In non tunneled,catheter is placed directly into venous system.

9) YES...Code is different for under age 5 and for age 5 and older.

10)Port : Port avoids need for needle stick and can be used for all kinds of IV therapy.It is flushed with heparin.

11)No; Same code is used for central(jugular,subclavian,femoral vein or IVC) and peripheral(basilic or cephalic vein).