Coding Hint: There is one diagnosis code and two CPT codes associated with this

Question

Coding Hint: There is one diagnosis code and two CPT codes associated with this report.

Operative Report

PROCEDURE:

Right radial arterial line placement.

Right internal jugular central line placement.

INDICATIONS FOR PROCEDURE: Preoperative hemodynamic monitoring and optimization prior to abdominal aortic aneurysm repair.

DESCRIPTION OF PROCEDURE: After informed consent had been obtained, the patient was placed in the supine position and the right side of the neck was adequately prepped and draped in the usual sterile fashion. Following this, the sternal and clavicle with the sternocleidomastoid muscle on the right side were marked out and local anesthetic was infiltrated at the apex of the triangle formed by the sternum and clavicle with the right sternocleidomastoid muscle.

The patient was placed in the Trendelenburg position. Following this, the right internal jugular vein was flushed out using an 18-French hollow needle with a syringe on negative suction.

Upon cannulation of the internal jugular vein, the syringe was removed from the hub of the needle and a guidewire was placed via the needle into the right internal jugular vein. The metallic needle was removed and the skin and subcutaneous tissues were incised using a scalpel along the position of the guidewire. Following this, the dilator was passed along the guidewire to dilate the skin, subcutaneous tissues, and the tract of the right internal jugular vein.

Following this, a 2-lumen catheter was placed over the guidewire into the right internal jugular vein to reach the right atrium. The guidewire was removed. All ports of the catheter were flushed with heparinized saline and free flow was obtained.

Following this, the catheter was sutured in place using 3-0 silk sutures and a transparent adhesive dressing was applied. The patient was taken out of the Trendelenburg position and the right wrist was prepped and draped in the usual sterile fashion.

After infiltration of local anesthetic, and 18-French Arrow catheter was used to locate the right radial artery. After adequate backflow was seen into the hub of the guidewire sheath, the guidewire was advanced into the right radial artery over which the catheter was advanced. Good backflow was obtained in the catheter and the catheter was flushed with heparinized saline and connected to the monitor to demonstrate adequate arterial pulse wave.

Subsequently, the catheter was kept in position using a sterile transparent dressing. Post procedure x-ray was obtained for the right internal jugular central line, which showed no evidence of hemothorax.

No post procedure complications. Blood loss nil.

Explanation / Answer

Diagnosis code for abdominal aortic aneurysm is 171.4

Procedure code for radial artery line placement 36620

Procedure code for central venous catheter placement is 36556

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