Ask Dr. Z

The physician here wants to charge for selection of third level vessel on the second day of thrombolysis. From what I am reading, catheter repositioning or exchange of previous placed intravascular is included. An example of dictation is as follows: "There is apparently a stenosis in the proximal anastomosis site probably that is the culprit causing the shutdown of the graft. There is still a decent amount of thrombus also in the anterior tibial artery, which is her main runoff, and there is a lot of thrombus in that artery, so we decided to do thrombolysis further into that artery. I was able to pull the catheter from the peroneal artery, which was a donor before, and then reselect the anterior tibial artery. Then we changed a new catheter and pushed the catheter into the artery, and we could not push further, just to the mid calf, so we then placed an infusion wire over that catheter and into the distal end of the anterior tibial artery. We could not do thrombolysis again today, so we are going to take patient back to check."