Ask Dr. Z

Do you recommend codes 36573 and 37248 for the following? "The left arm was prepared and draped in sterile fashion. The brachial vein was shown to be patent by ultrasound. A spot image was stored. The vein was punctured under direct sonographic guidance and local anesthesia. A wire was advanced to the SVC. The tract was dilated. The wire did not pass centrally. Contrast was injected to confirm a stenosis at the level of the thoracic outlet. Ultimately, a catheter wire was associated across the stenosis. 4 mm balloon angioplasty was performed to facilitate passage of the PICC line. The catheter was measured and cut to length. A dual lumen PICC line was placed through a peel-away sheath. The final tip was confirmed to be in the lower superior vena cava with a spot fluoroscopic image. The catheter was secured, flushed with Heparin, and a sterile dressing was applied. FINDINGS: Central venous stenosis at the level of thoracic outlet protruding wire passage. Area treated with 4 mm balloon angioplasty to facilitate PICC line placement."