# Help - venography question



## margaret fahy (Jul 30, 2014)

Hi Guys,
For the Venograms prior to thrombolytic infusion, bilateral, below....i am confused as to the correct venography code for each side....catheter into popliteal vein, femoral-popliteal venography done, then catheter into IVC where infusion catheter was placed. 
 So which are the proper venography/catheter placement codes to use in addition to 37212 X2?
This patient first had an IVC filter placed...as below.

The patient was placed in the supine position on the x-ray table
and an ultrasound of the right internal jugular vein was
performed to confirm patency. A suitable skin site was marked.
The right neck was prepared and draped in the usual sterile
fashion. Under ultrasound guidance with recording, a 21-gauge
micropuncture needle was utilized to access the right internal
jugular vein followed by the passage of a wire centrally.
Following sequential dilation, a Bentson wire was advanced into
the inferior vena cava over which the 7 French conduit of the
Gunther Tulip filter system was advanced and placed into the
suprarenal IVC where IVC venography was performed. The inner
dilator of the conduit was exchanged for a Gunther Tulip filter
which was deployed into the suprarenal, intrahepatic IVC with the
filter tip below the hepatic veins. Post-deployment venography
was performed through the sheath. The sheath was removed and
hemostasis was obtained at the right neck with manual
compression.


The patient was then moved into the prone position on the x-ray
table and an ultrasound of the right popliteal vein was
performed.  A suitable skin site was marked.  The bilateral
popliteal fossa were prepared and draped in the usual sterile
fashion.  Using ultrasound guidance with recording, a 21-gauge
micropuncture needle was advanced into the right popliteal vein
followed by the passage of an 0.018 Nitrex wire centrally. A 5
French micropuncture dilator was then inserted and the Nitrex was
exchanged for a 0.035 inch Bentson wire over which a 6 F vascular
sheath was placed. Right femoral-popliteal venography was
performed through the sheath. A Bentson wire, along with a 4
French Berenstein catheter, was manipulated into the IVC where
the intravascular distance was measured utilizing the Berenstein
catheter. Based on the measurement, a 5 French, 40 cm infusion
length Unifuse catheter was advanced with the infusion length
extending from the popliteal vein to the juxta filter IVC.

Attention was then turned to the patient's left popliteal fossa
where, under ultrasound guidance with recording, a 21-gauge
micropuncture needle was advanced into the left popliteal vein
followed by the passage of a 0.018 Nitrex wire centrally. A 5
French micropuncture dilator was inserted over the wire through
which left femoral-popliteal venography was performed. Over a
glide wire, the micropuncture dilator was exchanged for a 6
French vascular sheath. Left femoral venography was performed
through the sheath. The Glidewire, along with a 4 French
Berenstein catheter, was advanced into the IVC. The Berenstein
was exchanged for a 4 French, 20 cm infusion length UniFuse
catheter with the infusion length extending from the common
femoral vein to the caudal IVC.

A bolus of 2 mg of TPA was infused over 5 minutes via the right
popliteal sheath. Continuous infusions of 0.5 mg per hour of
 t-PA were connected to each infusion catheter for a total of 1
mg of t-PA per hour. The patient was transferred to the pediatric
ICU in stable condition and there were no immediate
complications.


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## Jim Pawloski (Jul 31, 2014)

margaret fahy said:


> Hi Guys,
> For the Venograms prior to thrombolytic infusion, bilateral, below....i am confused as to the correct venography code for each side....catheter into popliteal vein, femoral-popliteal venography done, then catheter into IVC where infusion catheter was placed.
> So which are the proper venography/catheter placement codes to use in addition to 37212 X2?
> This patient first had an IVC filter placed...as below.
> ...



I would bill 37191 for the IVC filter placement, and 37212-59 for the thrombolytic infusion.
HTH,
Jim Pawloski, CIRCC


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## suela923@aol.com (Aug 1, 2014)

Just wondering...couldn't you bill for the dx venograms and catheter placements as well?


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## Jim Pawloski (Aug 3, 2014)

suela923@aol.com said:


> Just wondering...couldn't you bill for the dx venograms and catheter placements as well?



No, they are bundled into the surgical code.  
Jim Pawloski, CIRCC


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## suela923@aol.com (Aug 4, 2014)

CPT book, pg 230  "Codes for catheter placement(s), diagnostic studies, and other percutaneous interventions (eg, transluminal balloon angioplasty, stent placement) provided may be separately reportable."

I think we would consider the venograms as dx studies and bill for them as well as the cath placements for them.  ??????


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## kdoughty (Apr 3, 2015)

Should we be billing for the 75825 (venography) during IVC filter placement?  I've read that it is bundled.


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## Chlrtrep (Apr 6, 2015)

It is my understanding you would code a dx venogram and  cath placement  in addition to the 37212.   37212,  includes RS&I for the images that may be required for inserting the catheter not to determine if treatment is required.


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