Ask Dr. Z

We could use your advice on how the following would be coded. We are unsure if the physician is describing an LVAD insertion or an ECMO cannula insertion. "Procedures performed: Placement of transseptal vent placement by right femoral venous approach. The patient is in cardiogenic shock, on ECMO, and brought for placement of transseptal vent to vent to the left ventricle. The right femoral vein was punctured, and a 0.032 inch wire was advanced into the right atrium. An SL 1 sheath was advanced over the wire into the right atrium. A BR K needle was advanced through the SL 1 sheath, and transseptal puncture was performed under transesophageal echocardiographic guidance. Following this, the SL1 sheath was removed over a 0.035 inch Boston stiff 03 5 inch guidewire. The septum was dilated, followed by placement of the transseptal cannula into the left atrium, position confirmed withTEE. Then the Y connector was connected to the ECMO circuit."