# Ir ivc filter insertion, all inclusive



## suela923@aol.com (Mar 20, 2013)

I know that the code 37191 is all inclusive for an IVC Filter insertion, but what if at the same time an iliac venogram was done?

A right iliac venogram was performed and demonstrated no evidence of thrombus within the proximal external iliac vein or common illiac vein.  The distal inferior vena cava looked normal.  The inferior venal caval filter deployment system was then inserted.  An inferior venacavogram was performed and showed a normal-appearing inferior vena cava.  No duplication or significant retroperitioneal collateral formation was demonstrated.  A Celect inferior vena caval filter was then deployed below the level of the renal veins within the inferior vena caval  Follow up venacavagram demonstrated excellent position of the filter.

I am not sure if the right iliac venogram should just be considered part of the all inclusive work of if it's billable by itself.  It's not normal to do this when doing a filter insertion.  All the other venocavagrams would be considered part of the inclusive code.

Any thoughts on this?  Thanks!!!

Sue


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## Jim Pawloski (Mar 20, 2013)

suela923@aol.com said:


> I know that the code 37191 is all inclusive for an IVC Filter insertion, but what if at the same time an iliac venogram was done?
> 
> A right iliac venogram was performed and demonstrated no evidence of thrombus within the proximal external iliac vein or common illiac vein.  The distal inferior vena cava looked normal.  The inferior venal caval filter deployment system was then inserted.  An inferior venacavogram was performed and showed a normal-appearing inferior vena cava.  No duplication or significant retroperitioneal collateral formation was demonstrated.  A Celect inferior vena caval filter was then deployed below the level of the renal veins within the inferior vena caval  Follow up venacavagram demonstrated excellent position of the filter.
> 
> ...



I would considered it the iliac venogram part of the IVC filter
Thanks,
Jim PAwloski, CIRCC


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## dpeoples (Mar 21, 2013)

Jim Pawloski said:


> I would considered it the iliac venogram part of the IVC filter
> Thanks,
> Jim PAwloski, CIRCC



I agree with Jim. The only exceptions I can think of would be an iliac venogram through a separate access, or if there was a _very clearly documented _separate medical necessity (diagnosis) for the iliac venogram.


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## suela923@aol.com (Mar 27, 2013)

My trainer says that this is billable because it's done to be sure there are no clots and that she has been billing it this way for a long time and nothing has come back and claims are being paid......only one of our doctors performs this extra venogram and I think it's just his way of doing this procedure.  I still don't feel comfortable billing for this.

Thanks,
Sue


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## Jim Pawloski (Mar 27, 2013)

suela923@aol.com said:


> My trainer says that this is billable because it's done to be sure there are no clots and that she has been billing it this way for a long time and nothing has come back and claims are being paid......only one of our doctors performs this extra venogram and I think it's just his way of doing this procedure.  I still don't feel comfortable billing for this.
> 
> Thanks,
> Sue



The Society Of Interventional Radiology stated that the IVC imaging was a "roadmap" for the placement of the filter.  The IVC filter is usually placed for PE or Ilower extremity thombosis. I think that the venogram would also fall into that category.
Thanks,
Jim Pawloski, CIRCC


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## suela923@aol.com (Mar 27, 2013)

Thanks, Jim.  I agree.


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