# pelvic congestion embolization tx



## Rita Bartholomew (Mar 17, 2011)

New to IR coding, so this is a tough one for me:
INDICATION:  PELVIC CONGESTION

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?


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## kbazarte@yahoo.com (Mar 18, 2011)

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


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## Rita Bartholomew (Mar 21, 2011)

So, we're looking at three different operative fields when assigning the embo code sets (37204 & 75894) and follow-up angiographies (75898)?


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## kbazarte@yahoo.com (Mar 21, 2011)

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.


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## kbazarte@yahoo.com (Mar 21, 2011)

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


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## Rita Bartholomew (Mar 22, 2011)

No fibroids or malignancy.  Thanks for your help!


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## MelissaBGT (Jan 10, 2022)

kbazarte@yahoo.com said:


> 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


Thank you for these responses!  I am also new to IR coding and coding a similar initial visit for emb, and then the return visit for identified fibroids.  Coding as if I don't know about follow-up visit, but please explain how initial case would be greatly different for uterine fibroids?  Thanx!


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## Jim Pawloski (Jan 11, 2022)

Coding for fibroids is 36247-50 for bilateral uterine artery catheterization and 37243 for tumor embolization. Also, 75898 is only used for cerebral embolizations.

HTH,
Jim Pawloski, CIRCC


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