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pelvic congestion embolization tx

  1. #1
    Greater Portland (Maine)
    Default pelvic congestion embolization tx
    Medical Coding Books
    New to IR coding, so this is a tough one for me:

    FINDINGS: The risks were explained and informed consent was obtained. A right groin puncture was made. Conscious sedation was used and a 5-French catheter placed into the vena cava and a venogram performed. Selective catheterization was then performed of both gonadal veins, both hypogastric veins and venograms performed at all locations. There is gross incompetence and gross dilation of the left gonadal vein. It was dilated upwards to 15 millimeters throughout. There is incompetence of the branches of the pelvic hypogastric vein which collateralizes this other vessel. Selective coil embolization was performed of the deep hypogastric to gonadal varices. Unfortunately, the size of the gonadal vein was larger than typical and I do not have the appropriate coil embolization devices to occlude it. The right gonadal vein was selectively catheterized and was found to be insufficient. This was successfully coil embolized with 4 coils. The deep pelvic branches on the left were embolized with two 15-millimeter coils. The right hypogastric system is widely intact. The femoral veins are noted to be normal in size and appearance.

    IMPRESSION: There is incompetence of both gonadal veins. The right was small and is successfully treated with coil embolization. On the left, the vein was quite dilated throughout, more than typical and I did not feel we could successfully embolize it with coils. At this point, we will evaluate for large diameter coils and possible Amplatz occlusion devices. The left hypogastric had some branches that communicated with the gonadal vein. These were embolized, deep in the pelvis. Stasis was achieved at the two embolization sites. At this point, we have plans to bring the patient back for subsequent treatment of the left gonadal vein.

    I get:
    36011 x 2 (rt gonadal, r hypogastric)
    36012 x 2 (lt gonadal, lt hypogastric)
    75833 S&I
    75825 IVC study
    37204 x 2, 75894 (embo)

    Am I on the right track?
    RCBartholomew, CPC-H, CEDC

  2. Default
    rt gonad 36011, lt gonad 36011-59 S&I 75822 (6. Bilateral ovarian venography is considered renal venography (75833).

    rt hypo 36011, lt hypo 36012-59
    IVC 75825

    Embolization lt deep hypo 37204, 75894 FU veno 75898
    rt gonad 37204-59, 75894-59, 75898-59
    lt deep pelvic branches 37204-59, 75894-59, 75898-59

  3. #3
    Greater Portland (Maine)
    So, we're looking at three different operative fields when assigning the embo code sets (37204 & 75894) and follow-up angiographies (75898)?
    RCBartholomew, CPC-H, CEDC

  4. Default
    not three operative fields but three vessels treated, the 75898 is for the FU angio post embolization.

    You did not state before, BUT if this is to treat a mailgnant tumor of uterine fibroid then the coding would be greatly different.

  5. Default
    not three operative fields but three vessels treated. The 75898 is for FU angio post embolization

    If this were being done for uterine fibroids or malignant tumor the coding would be greatly different

  6. #6
    Greater Portland (Maine)
    No fibroids or malignancy. Thanks for your help!
    RCBartholomew, CPC-H, CEDC

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