Ask Dr. Z

The patient was born with hypoplastic left heart syndrome who underwent staged palliation including Norwood/Sano, bidirectional Glenn anastomosis, fenestrated extracardiac conduit Fontan procedure, stent placement into Fontan fenestration and subsequent balloon angioplasty of stented Fontan fenestration and left pulmonary artery stent placement. She has plastic bronchitis and was scheduled for lymphatic imaging and possible occlusion of abnormal lymphatic collaterals to the lung. Transient balloon occlusion of Fontan fenestration was needed because of open fenestration with potential for right-to-left embolization of lipiodol droplets.

6F balloon wedge catheter was inserted thru right femoral venous sheath, advanced to extracardiac conduit and manipulated across stented Fontan fenestration. Transient balloon occlusion of Fontan fenestration was performed twice by interventional cardiologist during IR lymphatic procedure with lipiodol injection. I'd like to know how to report balloon occlusion of Fontan fenestration for facility and physician billing please.