venogram help

lmbroomall

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the pt's bilateral neck was prepped and draped in the usual sterile fashion. under US guidance, the right internal jugular vein was accessed. a 5 French sheath was placed. a superior venogram demonstrates complete occlusion of the right internal jugular vein with multiple collateral vessels around the base of the neck. next, US guidance was utilized to access the left internal jugular vein. a 5 French sheath was placed. a venogram was performed demonstrating occulusion of the central brachiocephalic vein. despite numerous attempts to recannulate the occluded portion of the central veins, this was not possible.
using the existing dialysis catheter, 2 stiff glidewires were advanced into the IVC. the existing dialysis catheter was removed. a 6 French sheath was placed. a venogram through the 6 French sheath demonstrated complete occlusions of the right internal jugular vein and proximal SVC. the existing dialysis catheter was removed and a new double lumen vaxcel dialysis catheter was passed over a wire through the tunnel, and into the internal jugular vein. under fluoro guidance, the tip of the catheter was positioned with int eh SVC.

impression: complete occlusion of the central right internal jugular vein and central left brachiocephalic vein. numerous collateral vessels are identified. stent could not be placed. successful replacement of dialysis catheter.

what cpts would you use since access was via jugular vein? a couple of coders have looked at this and come up with 36005 or 36000-50. 75820-lt (ir venogram; extremity). 75860-50 (ir venogram; jugular). 72827 (ir superior vena cava). everyone agrees on the cpt for the dialysis cath replacement.
any help would be appreciated. thanks
 

coffee2day

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Hi, I would use an unlisted code CPT 36299 for a non-selective jugular vein direct access without catheter advancement. CPT 36299 and 75860-26.
 

Chlrtrep

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Hi, I would use an unlisted code CPT 36299 for a non-selective jugular vein direct access without catheter advancement. CPT 36299 and 75860-26.

This was the recommendation at a Dr. Z conference. As CPT 36005 for extremity venography the IJ not being an extremity vein. CPT 36299 for Unlisted procedure, vascular injection
 
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