Which Venography Codes?

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Hi,
I have 37212 and 36012/75820, and 76937....not sure of other venography codes. Please help.
Using ultrasound
guidance a 21 gauge needle puncture needle was advanced into the
left distal popliteal vein and once blood return was obtained at
0.0 18 Mandril wire was advanced under fluoroscopic guidance. A 5
French micropuncture dilator was then inserted and 0.018 inch
Mandril was exchanged for a 0.035 inch Newton wire after dilating
the tract, a 8F vascular sheath was placed. Using a JB-1 catheter
and a 0.035" glidewire the catheter was manipulated into the
femoral, external iliac and common femoral vein and contrast was
injected at each site demonstrating extensive expanding occlusive
thrombus from the distal femoral vein to the iliac bifurcation
with refluxing of contrast into small collateral and lumbar
veins. A cavogram was performed showing no evidence
 

Jim Pawloski

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Hi,
I have 37212 and 36012/75820, and 76937....not sure of other venography codes. Please help.
Using ultrasound
guidance a 21 gauge needle puncture needle was advanced into the
left distal popliteal vein and once blood return was obtained at
0.0 18 Mandril wire was advanced under fluoroscopic guidance. A 5
French micropuncture dilator was then inserted and 0.018 inch
Mandril was exchanged for a 0.035 inch Newton wire after dilating
the tract, a 8F vascular sheath was placed. Using a JB-1 catheter
and a 0.035" glidewire the catheter was manipulated into the
femoral, external iliac and common femoral vein and contrast was
injected at each site demonstrating extensive expanding occlusive
thrombus from the distal femoral vein to the iliac bifurcation
with refluxing of contrast into small collateral and lumbar
veins. A cavogram was performed showing no evidence
I don't see any evidence of the catheter in the vena cava. So for catheter I would code 36005, and not code 76937 because of lack of information on the ultrasound. 37212 and 75820 I agree with.
HTH,
Jim Pawloski, CIRCC
 
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Question re Reply Which Venography Codes

Jim,
Thanks so much.
Questions:.....why is it just 36005 when the catheter was advanced to femoral, ext. iliac and com.fem.veins for venography? I'd really like to understand this better.
Also....in re documentation for 76937...I cut this out.....A limited US of distal popliteal vein was performed to confirm patency....would this suffice to bill 76937?
Thanks so so much.
 

Jim Pawloski

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Jim,
Thanks so much.
Questions:.....why is it just 36005 when the catheter was advanced to femoral, ext. iliac and com.fem.veins for venography? I'd really like to understand this better.
Also....in re documentation for 76937...I cut this out.....A limited US of distal popliteal vein was performed to confirm patency....would this suffice to bill 76937?
Thanks so so much.
For the catheter, all those veins are in a straight line, not branches of the vein. As to 76937, was an image saved of the needle entering the vein? That is stated in the description of 76937.
Thanks,
Jim
 
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Jim,
Thanks...so if the catheter is advanced in a straight line to other veins and not off to branches, then it would still be 36005....I see...….and yes, permanent images were stored, with reference to the 76937.
Thanks so much for the enlightenment re the straight line as opposed to branches.....
 
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I think we need to ask physician whether the catheter was placed in IVC or not. Because he stated that "cavogram performed". If he replies as catheter was placed in IVC then need to 36010, 75825 instead of 36005.
 

Jim Pawloski

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I think we need to ask physician whether the catheter was placed in IVC or not. Because he stated that "cavogram performed". If he replies as catheter was placed in IVC then need to 36010, 75825 instead of 36005.
Not documented, so no can do. You can see the IVC from a femoral injection. Try 10cc per sec for 20 cc total.
Jim Pawloski, R.T. (R)(CV), CIRCC
 
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