# Venogram (IVC) help please



## TWilliam2019 (Sep 2, 2014)

Procedures
Right heart catheterization, left heart catheterization, coronary angiography, left ventriculography and central venography.
Indication
Dyspnea, abnormal nuclear stress imaging with inferoapical ischemia
Clinical
Mr. Smith is a 70-year-old male with 3 months of increasing shortness of breath on exertion, tis was fairly sudden onset. He has been diagnosed via CT with honeycombing suggesting pulmonary fibrosis, moderate-to-severe pulmonary hypertension on echo estimation, preserved LV function with abnormal nuclear stress imaging as above. Right and left heart catheterization was recommended by his cardiologist in Greenwood. Subsequently, he sought a second opinion and saw Dr.Nawabi. Dr.Nawabi recommended the same. He does have a history of recurrent DVT and pulmonary emboli and is on chronic Coumadin. I was asked to perform the procedure.
Procedure In Detail
After informed consent was obtained, the patient was brought to the cath lab, prepped and draped in the usual sterile fashion. Lidocaine was used for local anesthesia and Versed for sedation. Seldinger technique was used to cannulate the right femoral vein and place a 7-French venous sheath. With some difficulty due to some mild-to-moderate stenosis in the right iliac vein and with the use of a Swan wire, the Swan-Ganz catheter was gently inserted to the region of the IVC filter. It was deiced previously given the patients pulmonary fibrosis and chronic coughing that attempted internal jugular or subclavian venous cannulation without general anesthesia would be difficult and potentially dangerous. Subsequently, we attempted to pass the probe and the Swan-Ganz catheter beyond the IVC filter. Unfortunately, the IVC was completely occluded with collateral flow around the IVC Filter. Venography was performed in this region. Subsequently, attempts were abandoned, the central venous pressure was obtained and subsequently, the Swan-Ganz catheter was removed. Seldinger technique was then used to cannulate the right femoral artery and place a 5-French arterial sheath. JL4 and 3D RC catheters were used for selective coronary angiography. A pigtail catheter was then advanced to the left ventricle for hemodynamic monitoring and left ventriculography. Following the procedure, catheters and sheaths were removed and hemostasis was obtained using manual compression.
the rest of the dictation completes a LHC
how would you code this?


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## Jim Pawloski (Sep 2, 2014)

kashyatt@aol.com said:


> Procedures
> Right heart catheterization, left heart catheterization, coronary angiography, left ventriculography and central venography.
> Indication
> Dyspnea, abnormal nuclear stress imaging with inferoapical ischemia
> ...



I would code 93458, 36010, 75825.  Cannot bill for right heart, since it was not performed.
HTH,
Jim Pawloski, CIRCC


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## TWilliam2019 (Sep 3, 2014)

*venogram*

Thanks so much  What books would you recommend to learn Pacer/Defibs and EP?  I will start coding these in 2 weeks and want more learning materials.


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## Jim Pawloski (Sep 3, 2014)

kashyatt@aol.com said:


> Thanks so much  What books would you recommend to learn Pacer/Defibs and EP?  I will start coding these in 2 weeks and want more learning materials.



I use Z-health Publishing's Interventional Cardiology & Interventional Cardiology book.  A little pricey, but a great book.

Thanks,
Jim Pawloski, CIRCC


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## TWilliam2019 (Sep 4, 2014)

*veneogram help*

Can you explain how you came to codes 36010 and 75825?  I am learning and just want to understand why you choose these. Thanks so much for your time.


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## Jim Pawloski (Sep 5, 2014)

kashyatt@aol.com said:


> Can you explain how you came to codes 36010 and 75825?  I am learning and just want to understand why you choose these. Thanks so much for your time.



Catheter placed in the IVC is 36101, and 75825 is the inferior venocavaogram.

Jim


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