Radiology Coding Alert

Question: Is there a CPT Code for a portogram? I can't find one in the CPT manual .

Ohio Subscriber

Answer: Most providers and payers use the term "portogram" to describe a study of the liver's portal venous system. Radiologists normally perform such studies via a direct injection into the portal vein. Physicians can also study the portal system, however, after a high-volume injection of contrast into the splenic and/or superior mesenteric arteries. If you performed a portal vein angiogram by directly injecting the portal vein, you should report 36481 (Percutaneous portal vein catheterization by any method) with either 75885 (Percutaneous transhepatic portography with hemodynamic evaluation, radiological supervision and interpretation) or CPT 75887 (Percutaneous transhepatic portography without hemodynamic evaluation, radiological supervision and interpretation). The significant difference between the two RS&I codes is determined by whether or not you obtained and documented hemodynamic measurements.

If you obtained the portal vein study via a primary arterial injection, you should report 75887 along with the vascular catheterization code (usually 36245- 36246). You should not report the portal vein study if the portal vein evaluation is not the primary purpose for the arterial injections. In this case, you should only report the arteriogram RS&I, because the "incidental" portal venogram is included in the arteriogram. Some practices misuse the term "portogram" to describe the study of a subcutaneous venous access port. If you performed such an injection into a port, you should instead report 36299 (Unlisted procedure, vascular injection) with either 76000 (Fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]) or 76003 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]) for the fluoroscopic guidance.