decisionhealth Newsletters, Coder Pink Sheets - 2008 Issue 4 (April)
Interventional case file
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Article Overview
This regular coding case file presents a brief operative note involving placement of an implantable venous access port and the related imaging support described in the report. It is intended for coders and coding educators who want to compare the documentation against the codes selected in the case discussion. The article focuses on identifying the relevant procedural setting, the type of access device described, and the accompanying fluoroscopic guidance component.
Why This Topic Matters
Accurate coding for vascular access procedures depends on recognizing the documented approach, device type, and imaging assistance in the operative record. This case illustrates how documentation details in a short report are used to support procedure selection in a coding education context.
Article Sections
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Radiological exam and procedure note
A short operative-style note describes the documented insertion procedure, access site, device placement, and imaging confirmation used in the case discussion.
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Case File Answer: Coding
The article presents the consultant’s coding discussion for the case and identifies the procedure and imaging code selections used in the example.
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Commentary
A brief explanation summarizes the documentation clues that supported the coding discussion.
What You Will Learn
- How a venous access port placement case is presented in a coding education format
- What documentation elements are emphasized in reviewing a vascular access procedure note
- How imaging support is discussed alongside the primary procedure in a case review
- How a consultant explains the reasoning used in a coding example
Who Should Read This
- Medical coders
- Coding educators
- Revenue cycle professionals
- Interventional radiology coding staff
Codes Discussed
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