Radiology Coding Alert

Focus on laterality for renal and hemodynamics for hepatic and portal assessments.

For evaluation of venous blood returning from abdominal viscera, you can focus on renal, hepatic, and splenic venograms. You can easily make your way to the right code by carefully reading the procedure note for specific details. Here is how you can ensure you never err on a claim for abdominal venograms.

Check Unilateral/Bilateral For Renal and Adrenal Venograms

When your physician does a renal venogram, you need to check if the procedure was done on one or both sides to determine the right code. You submit code 75831 (Venography, renal, unilateral, selective, radiological supervision and interpretation) for a unilateral renal venogram and 75833 (Venography, renal, bilateral, selective, radiological supervision and interpretation) for a bilateral renal venogram.

Distinguish renal and adrenal venograms: You have specific codes for adrenal venograms. Like the codes for renal venography, you select the right code depending upon unilateral or bilateral procedure. Accordingly, you submit codes 75840 (Venography, adrenal, unilateral, selective, radiological supervision and interpretation) or 75842 (Venography, adrenal, bilateral, selective, radiological supervision and interpretation).

Tip: When your radiologist performs bilateral abdominal venograms, always check your CPT^® manual for a bilateral code before simply reporting a unilateral code two times.

Hemodynamic Assessments Rule Portography and Hepatic Venography

You may read that your radiologist advanced a needle from the hepatic vein to enter the portal vein and then positions the wire and the catheter. You may further read that your provider determined the blood pressure, blood flow, and oxygen levels during the portography. For this procedure, you submit code 75885 (Percutaneous transhepatic portography with hemodynamic evaluation, radiological supervision and interpretation).

If however, your provider only does the portography and does not determine the pressure readings, you submit code 75887 (Percutaneous transhepatic portography without hemodynamic evaluation, radiological supervision and interpretation). The descriptor of this code clearly mentions no hemodynamic evaluation is done.

Also: When submitting codes 75885 and 75887, you can also submit code 36481 (Percutaneous portal vein catheterization by any method) for the percutaneous catheterization of the portal vein. 

Hemodynamic assessments also apply to hepatic venography: When your physician does a hepatic venography with hemodynamic evaluation, you submit code 75889 (Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation). If your provider does not do a hemodynamic evaluation, you submit code 75891 (Hepatic venography, wedged or free, without hemodynamic evaluation, radiological supervision and interpretation).

Note: Hepatic venography codes, 75889 and 75891, apply to both wedged and free hepatic venograms.

What does ‘wedged’ mean? The term ‘wedged’ in code descriptors for 75889 and 75891 imply use of carbon dioxide as contrast. You may read that your physician injected carbon dioxide through the catheter with a balloon wedged in the middle or right hepatic vein. The carbon dioxide here acts as a contrast. This procedure may demonstrate a retrograde flow of gas into the portal vein or reflux in the hepatic vein.

Exception: If your physician does not perform any imaging procedure but only determines the hepatic wedged or free hepatic vein pressures, you may submit code 75889 and append modifier 52 (Reduced services) to imply the reduced services.

 Spot Specific Code for Splenoportography and IVC Venography

Your physician may perform a splenoportography in a patient with bleeding esophageal varices before surgical intervention for the bleeding varices, to find the cause for portal hypertension, or as a follow-up assessment after portosystemic shunt procedure when the spleen was preserved. For splenoportography, you turn to code 75810 (Splenoportography, radiological supervision and interpretation).

The codes for selective imaging of visceral veins do not include inferior vena cavography. If you read that your physician did a venogram of inferior vena cava, you submit code 75825 (Venography, caval, inferior, with serialography, radiological supervision and interpretation).