# Superior Mesenteric Venography w/Portography & Angioplasty



## margaret fahy (May 12, 2014)

Guys,
How am I to code for the SMV Venography?....
I also have 36481, 75885, 35476, 75978....
Can't find info on the SMV Venography....would it be 36011 or 36012 & ?...no more 75774, from what I've read?...

Exam:  IR PTA Venous
IR Venogram Portal W/ Hemodynamics  Completed:  05/08/2014 12:01 PM
05/08/2014 12:01 PM  
Appt Loc:  Main Interventional      
Attending:     


Indications:    
Diagnosis:Status post liver transplantation [V42.7 (ICD-9-CM)]<br />Portal vein stenosis [459.2 (ICD-9-CM)]
Status post liver transplantation [V42.7 (ICD-9-CM)]<br />Portal vein stenosis [459.2 (ICD-9-CM)]    
Reason:7 yo with hx of biliary atresia s/p liver transplant in 2007 with hx of portal vein stenosis, portal hypertension and esophageal varices/bleeding, s/p repeat angioplasty in IR
7 yo with hx of biliary atresia s/p liver transplant in 2007 with hx of portal vein stenosis, portal hypertension and esophageal varices/bleeding, s/p repeat angioplasty in IR    

Interpretation:    

PERCUTANEOUS PORTAL VEIN ANGIOPLASTY W PRESSURE MEASUREMENTS:  
CLINICAL HISTORY: Gastric and esophageal varices, splenomegaly,
multiple variceal bleeds. s/p liver transplant. Prophylactic
portal vein angioplasty as patient has bled at interval of 1 yr
post prior angioplasty. To date no bleeding post angioplasty.
Recent US showed high velocity jets and narrowing at anastomosis
to 3mm.
COMPARISON: Portal Vein Angioplasty 3/2014, US 5/6/14
PROCEDURE: An US examination was performed of the right and main
portal vein was performed and an access site for needle access
was identified. The patient was prepped and draped in sterile
fashion.  
Using US guidance a 21g micropuncture needle was advanced in a
junction of right portal vein and main portal vein. An 0.018 inch
Nitrex wire was inserted through the needle and the wire
traversed the main portal vein stricture. A 4 French stiffened
micropuncture set was advanced over the main portal vein under
fluoroscopic  
guidance. The micropuncture sheath was serially exchanged for a
6French vascular sheath.  
A 4 Fr JB1 catheter was advanced over the wire into superior
mesenteric vein. Venography was performed. Pre and post stenotic
pressure were obtained. Based on the results of the pressure
gradient, image findings, and discussion the decision was made to
repeat the angioplasty of the stenosis. Angioplasty was performed
with a  6mm 2cm, 8mm 2cm Conquest balloons and a 10mm x 4cm
Mustang balloon. No significant waist was seen after each
insufflation to nominal balloon pressure.  Post angioplasty
venogram was performed. Post angioplasty pressure measurements
and gradient were obtained.  

The sheath was withdrawn and gelfoam tract embolization with
pledgets was performed via a 6F peel away sheath of the hepatic
access tract during removal. No post removal tract bleeding was
identified. There were no  
complications and the patient left the IR suite in stable
condition. Dr. l was present for the entire procedure.


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## margaret fahy (May 14, 2014)

*Can i get some input-smv angiography w/portography*

Hey Guys,
Would someone please give me some input on my question?  Thanks so much.


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## dpeoples (May 15, 2014)

margaret fahy said:


> Guys,
> How am I to code for the SMV Venography?....
> I also have 36481, 75885, 35476, 75978....
> Can't find info on the SMV Venography....would it be 36011 or 36012 & ?...no more 75774, from what I've read?...
> ...



Just at a glance....I do not see an interpretation of images for 75885 nor for the SMV injection (there is no code for a SMV venogram anyway). All that is documented is:
35476/75978
36481(portal vein)  and 36011 (SMV).

HTH


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## margaret fahy (May 15, 2014)

Dan,
Oh..so sorry...I just looked at the report again...somehow I cut out the Pressure Measurements, as below.  So, then with thse documented, my codes are okay....

Hemodynamic pressure measurement in portal vein pre angioplasty  
Pre stenosis SMV: 16 mmHG  
Post stenosis: 12 mmHG  
Gradient: 4  
Post angioplasty:  
Pre stenosis SMV:16 mmHG  
Pre stenosis Splenic Vein: 15mmHg
Post stenosis:12 mmHG  
Gradient: 4 unchanged  

Thanks so very much, as usual, for your learned input.
Margie


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## dpeoples (May 15, 2014)

margaret fahy said:


> Dan,
> Oh..so sorry...I just looked at the report again...somehow I cut out the Pressure Measurements, as below.  So, then with thse documented, my codes are okay....
> 
> Hemodynamic pressure measurement in portal vein pre angioplasty
> ...



Not really. Pressure measurements and angiography (interpretations) are not the same thing. Pressure measures are just a part of catheterization. Angiography/Venography is production and interpretation of images. 

HTH


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