Ask Dr. Z

A SVC cavogram was performed through the catheter which showed a fibrin sheath in SVC. A 12 mm angioplasty balloon was advanced over the guide wire. The balloon was inflated in three different segments of SVC. A follow up cavogram showed widely patent SVC without any fibrin sheath. Subsequently a new tunnelled dialysis catheter was advanced over the guide wire. The 13.5F dialysis catheter wa tunneled under skin over right upper chest and then introduced over the guide wire with the tips positioned in right atrium under fluoroscopy guidance. The catheter was flushed with heparinized saline and sutured to skin with 2.0 Silk. IMPRESSION: 1.Successful replacement of a right jugular tunneled dialysis catheter. 2. Successful removal/disruption of fibrin sheath with angioplasty balloon. Is it appropriate to bill: 36581, 77001, 36595-52? Thank you.