Wiki guidance needed for catheter coding

[kvo]

We could really use some guidance and clarification in the catheter placement coding during venography procedures. Our physicians tend to gain bilateral access, femoral, and perform injections for venograms, from there they advance both wires to IVC and perform IVUS of the IVC, bilateral common and external iliacs, and then the bilateral common femorals. Since catheters advancing to IVC 36010 bilateral? Sometimes they stop there but other times they may then place a stent in either the right or left common iliac. At that point are we getting the 36010 for the one side and then the catheter placement of the stent 36011? Some physicians are asking for a 36005 and a 36010. I even had a physician asking for 36005-50 and a 36010. Even the coders here have different opinions on how this should be coded. Any input is so greatly appreciated.

Thank you,
Kim

 

[Jim Pawloski]

In you case of bilateral femoral vein access, and catheters going into the IVC for IVUS, yes you can code 36010-50. Then the IVUS would be coded 37252 for one side and 37253 for the other side assuming that a pull back technique was done. If the catheter is not documented to be in the IVC, then you are coding 36005. Venous stent placements are coded 37238 and 37239. 36011 is a selective code, so they have to select a vessel that comes off whatever vessel they are in. So if you go from the femoral vein to the IVC, and then to the renal vein, that is when you use code 36011.
HTH,
Jim

 

[vidraj]

Hi Jim, isn't the catheter placement code 36011 inclusive with the 37238/37239 here?

I am learning on these vein interventions and I thought similar to lower extremity arterial revascularitization codes, the cath placement is bundled when they get intervened.Can you please clarify?

Also, if only the IVUS( 37252, 37253) are performed as a diagnostic study, without any stent placement - can I submit the Cath placement code separately or is that inclusive here too? Technically, IVUS codes are add on codes and I thought we have to submit the 36011 as the first code in such scenarios.

I am looking for an urgent review and any help is appreciated. Thank you!