# Portal venography-please help



## margaret fahy (Aug 23, 2013)

08/23/13
Hi,
Haven't gotten even one response for my previous question.  
Is there anyone out there who can help me?
Any input will be appreciated.
Margie

Hi, Guys,
Can someone help me with these codes....the venographies of the Splenic, SMV and IMV, along with a 36481/75885. Is it 306012-Splenic, and 36011 X2 for the SMV and IMV? Report below:
: CLINICAL HISTORY: 10 year old male patient with history of 
hyperinsulinemia, presents for portal vein sampling.

COMPARISON: CT of the abdomen 7/5/2013.

CONSENT: Benefits and risks, including but not limited to
bleeding, infection, vessel injury and vessel occlusion, were
explained to the patient's parent who gave verbal and written
consent.

TIME OUT: Prior to the procedure a "time out" was performed
with all team members present. During the "time out" the
patient, procedure, and site were verbally....

PROCEDURE TIME: 6.5 hours.


PROCEDURE:

1. Transhepatic access of the right portal vein.

2. Portal venography with and without ballon.

3. Selective catheterization of pancreatic and portal vein
branches and blood samples.

4. Access site embolization using Gelfoam pledgets.

PROCEDURE IN DETAILS:

Limited ultrasound examination of the liver was performed to
identify the portal vein branch for access. The anterior branch
of the right portal vein was chosen. The skin overlying the site
was marked. The right upper quadrant was prepped and prepped in
usual sterile manner. The anterior branch of the right portal
vein was accessed under ultrasound guidance utilizing a 21-gauge
7 cm needle through the anterior approach. Once venous blood
return was obtained a 0.018 Nitrex wire was inserted into the
vein and advanced to the main portal vein. Then a small
dermatotomy was made, the tract was dilated, and 5 French
vascular sheath was inserted into the vein. 4 French pigtail
catheter was advanced over the wire into the proximal portion of
the splenic vein and portal venography was obtained. The
contrast refluxed into the proximal portion of the superior
mesenteric vein. The catheter was exchanged to 4 French JB1 and
multiple blood samplings were obtained from the superior, middle
and inferior intra-splenic tributaries of the splenic vein.

Then portal venography was performed after inflation of 4 French
Fogarty balloon at the portal confluence which demonstrates
reflux of the contrast into the inferior mesenteric vein where a
few blood samples were obtained utilizing 4 French JB 1
catheter. Portal venography was performed after inflation of 3
cm x 6 mm angioplasty balloon at the portal confluence, there
was no satisfactory reflux of contrast into the pancreatic
veins. Then the vascular sheath was upsized into 6 French sheath
and a 5 French Fogarty balloon was inflated at the junction of
superior mesenteric and splenic veins and portal venography was
obtained which demonstrates reflux of the contrast into anterior
and posterior superior pancreaticoduodenal veins, main
pancreatic vein as well as into a few venous tributaries around
the pancreatic head. Several blood samples were obtained from
the pancreatic veins in the region of the pancreatic tail, body
and head utilizing 3 French JB1 catheter and 2.5 French angled
microcatheter. After satisfactory number of blood samples the
6F vascular sheath was removed and the tract was embolized using
Gelfoam pledgets. Post procedure ultrasound demonstrates a small
subcapsular fluid collection around the hepatic tract. The skin
was cleaned and sterilized dressing was applied.

There were no complications and the patient left the IR suite in
stable condition. 

FINDINGS: Limited ultrasound of the liver showed a patent portal
vein. Under ultrasound guidance 


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## dpeoples (Aug 23, 2013)

margaret fahy said:


> 08/23/13
> Hi,
> Haven't gotten even one response for my previous question.
> Is there anyone out there who can help me?
> ...



This is a venous sampling case. Selection and imaging are bundled into the codes for venous sampling. This is coded per organ sampled (the pancreas in this case) not vessel sampled. All you have is:
36500/75893

HTH


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## margaret fahy (Aug 25, 2013)

*Venous Sampling*

Danny,
Of course you're right...now I see it.
Thanks so much.
Margie


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