Sclerotherapy-the venous codes

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37241 & 36012 or 36005? left leg/thigh venous malformation examined with US. suitable access site for needle

placement was id'd and skin marked. Left leg prep/draped from upper

thigh to ankle. Using US guidance access into

multiple hypoechoic venous structures with a 21 gauge needle was performed along lateral distal thigh & proximal leg. Initially blood return was noted and contrast was injected- demonstrated small and large outflow veins,

type 2 drainage.

Therefore, balloon occlusion technique via percu

retrograde access into the large abnormal outflow vein seen draining into the popliteal vein was performed after placement of

a 5F Vascular sheath via 0.018" Nitrex and micropuncture sheath.

Over a 0.035" wire, a 6 mm x 40 mm Mustang balloon was advanced

through vascular sheath and positioned just proximal to the inflow to popliteal vein. The balloon was inflated. After confirming adequate outflow occlusion w/contrast injxn,30% glue solution.,US guid. used to access distal point in lateral mid leg (site 1)-glue injxn...vasc.sheath wire removed-3 addt'l sites treated.
 

ernist8489

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37241 & 36012 or 36005? left leg/thigh venous malformation examined with US. suitable access site for needle

placement was id'd and skin marked. Left leg prep/draped from upper

thigh to ankle. Using US guidance access into

multiple hypoechoic venous structures with a 21 gauge needle was performed along lateral distal thigh & proximal leg. Initially blood return was noted and contrast was injected- demonstrated small and large outflow veins,

type 2 drainage.

Therefore, balloon occlusion technique via percu

retrograde access into the large abnormal outflow vein seen draining into the popliteal vein was performed after placement of

a 5F Vascular sheath via 0.018" Nitrex and micropuncture sheath.

Over a 0.035" wire, a 6 mm x 40 mm Mustang balloon was advanced

through vascular sheath and positioned just proximal to the inflow to popliteal vein. The balloon was inflated. After confirming adequate outflow occlusion w/contrast injxn,30% glue solution.,US guid. used to access distal point in lateral mid leg (site 1)-glue injxn...vasc.sheath wire removed-3 addt'l sites treated.
Hello Margaret.
So For this case We would ONLY assign
- 37241.
36005 is bundled into 37241 and per the documentation inherent to the Embolization.
Since a catheter was not documented as being inserted into an extremity vein and selectively advanced into 2 or more higher order venous branches per the documentation we would not assign 36012. As 36012 we assign for 2nd order selective venous catheterization or higher order.
So everything in this case is bundled into 37241. Feel free to Contact me for any questions relating to IR, CVIR, Vascular/Neurointerventional, Cardiology or any other related specialty.
Erik Brown, CIRCC, CPC
 
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Hello Margaret.
So For this case We would ONLY assign
- 37241.
36005 is bundled into 37241 and per the documentation inherent to the Embolization.
Since a catheter was not documented as being inserted into an extremity vein and selectively advanced into 2 or more higher order venous branches per the documentation we would not assign 36012. As 36012 we assign for 2nd order selective venous catheterization or higher order.
So everything in this case is bundled into 37241. Feel free to Contact me for any questions relating to IR, CVIR, Vascular/Neurointerventional, Cardiology or any other related specialty.
Erik Brown, CIRCC, CPC
Erik,
Thanks so very much. Bundling aside, I get confused w/these venogram codes...e.g...why does book give 36012 for catheterization of pop.vein, when, unless 2nd order selective or higher, it should not be 36012...if this were not bundled, it would be 36005 for my report, correct?
 

ernist8489

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Erik,
Thanks so very much. Bundling aside, I get confused w/these venogram codes...e.g...why does book give 36012 for catheterization of pop.vein, when, unless 2nd order selective or higher, it should not be 36012...if this were not bundled, it would be 36005 for my report, correct?
Yea your correct because it's direct needle access versus a selective catheterization.
2nd order, 3rd order Nd all superselective venous cath is 36012.
 
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