medical coding reimbursement

PROCEDURE: Right internal jugular vein tunneled hemodialysis catheter placement. PRE-PROCEDURE DIAGNOSIS:   End-stage renal disease. Patient needs long term central venous access for hemodialysis. SEDATION: I was personally responsible for the administration of moderate sedation services during the procedure performed.  I confirm all of the requirements of moderate sedation were followed.  This included the use of an independent trained nurse who had no other duties during the procedure.  The drugs utilized were midazolam and fentanyl.  Continuous monitoring and face-to-face time began at 1707 hours and ended at 1747 hours.  Total minutes and further documentation can be found in the nursing/procedure log for this encounter date of service. TECHNIQUE: After application of 1% lidocaine for local anesthesia, the right internal jugular vein was accessed with a micropuncture system with real-time ultrasound visualization of vascular needle entry and permanent image recording. A guidewire was advanced under fluoroscopic guidance. A short incision was made in the infraclavicular region.  A subcutaneous tunnel was made to the venotomy site, through which the catheter was placed. The venotomy was dilated to accept the peel-away sheath, through which the leading end of the 14.5-French, 23 cm HemoStar dialysis catheter was advanced under fluoroscopic guidance.  Catheter tip positioned in the mid right atrium. The venotomy incision was closed with absorbable suture and skin adhesive, and the catheter was secured to the skin with suture.   There was good flush and aspiration through both catheter lumens.  All lumens were flushed with heparin solution. Post-placement radiograph was obtained. A sterile dry dressing was placed over the catheter exit site. The procedure was well-tolerated without immediate complications. MEDICATIONS: Midazolam 0.5 mg IV Fentanyl 25 mcg IV Lidocaine 1% subcutaneous RADIATION DOSE: Air Kerma 12.7 mGy FLUOROSCOPIC TIME: 0.8 minutes. ESTIMATED BLOOD LOSS: None SPECIMENS OBTAINED: None. COMPLICATIONS: None. FINDINGS: 1. Ultrasound demonstrates a patent right internal jugular vein. 2. Post-placement radiograph shows an appropriately positioned tunneled catheter with the tip at the right atrium.

Impression: IMPRESSION: Successful placement of tunneled right internal jugular hemodialysis catheter (14.5-French, 23 cm HemoStar dialysis catheter). The catheter is ready for immediate use.