Ask Dr. Z

The physician wants to code a venoplasty and a stent placement in this case. I am leaning more towards a thrombectomy since the physician is describing clot not stenosis and I'm aware that mashing a clot with a balloon catheter is not an angioplasty. It seems that the underlying issue here is compression from a tumor with resulting narrowing of the vessel. Please tell me if my codes are correct: 36299, 75827, 36010, 37187, 37205, 75960. I chose the 36299 as I can't tell from his dictation where he was when he initially injected contrast but since he accessed the IJ it seems he was nonselective. Thank you very much! Patient with lung cancer and significant face and head swelling secondary to SVC syndrome. Patient is here for further evaluation and possible treatment. PROCEDURE: Using a micropuncture kit and under direct ultrasound visualization, the right internal jugular vein was accessed and an 0.018 wire advanced. The needle was removed and a 4 FR conversion sheath inserted over the wire. Wire and introducer were removed and runs were done demonstrating extensive clot and tumor burden seen within the right internal jugular vein. The right braciocephalic vein and the proximal SVC. Using glidewire, access into the right atrium was achieved. Sheath was up-sized to a 7-French vascular sheath. Angioplasty was performed using a 10X6 balloon. Using a 12X40 Smart stent, this area was then secondarily stented as there was no significant interval improvement. Follow-up runs demonstrated mild improvement with residual high-grade stenosis and using a 12X40 Atlas stent, this area was then re-angioplastied. Follow-up runs demonstrated marked improvement but with significant residual stenosis which was refractory to further angioplasty. There is, however, no relux seen up towards the head. Tumor involvement is seen within the proximal right atrium.