# Internal Iliac Sclerotherapy



## dhuston (Jun 18, 2009)

What, if anything, would you code for the sotradecol injection and what code would you use for an internal iliac venogram?

Thanks,
Diane



Pelvic congestion syndrome, persistent unimproved pelvic pain despite bilateral gonadal vein embolizations

Moderate sedation was employed using Versed and Fentanyl titrated for patient comfort by a trained independent observer. Continuous physiologic monitoring vital signs was performed for approximately 105 minutes.

Lidocaine was administered locally. A small dermatotomy was made and a micropuncture needle was placed into the right internal jugular vein. Ultrasound guidance was used. A hardcopy image was saved. An 0.018" wire was easily passed. A micropuncture sheath assembly was advanced and a Benson guidewire was then advanced into the IVC.

A 6 French sidearm sheath was then placed into the IVC. Using AP venous catheter, the right internal iliac vein was catheterized contrast was injected to confirm position. The catheter was then advanced over a wire into the main trunk draining pelvic varicosities. A 1 cc Foley catheter was then advanced over an exchange length Bentson guidewire and the balloon was insufflated proximally 0.3 cc of dilute contrast to include flow. Approximately 5 cc of contrast was then gently injected to fill numerous large pelvic varicosities.

Access was then gained into the left internal iliac vein and contrast was injected. A 1 cc Fogarty catheter was then placed into the left internal iliac vein and contrast was injected following insufflation of the balloon.

Access was regained into the right internal iliac vein varicosity. The portable gland was insufflated to occlude flow and 3 cc of 3% Sotradecol was then administered. This was allowed to dwell for 5 minutes. Repeat venogram was performed which demonstrated decreased size of varicosities.

The catheter was removed and manual compression was used to achieve hemostasis.


FINDINGS:
1. Initial right internal iliac vein venogram demonstrates numerous large varicosities in the pelvis. The majority of these are present inferiorly. Treatment was performed only of the more inferior varicosities. Post sclerotherapy venogram demonstrates significant decrease in size of varicosities. 2. Left internal iliac vein venogram demonstrates several mildly enlarged pelvic veins. These are much less impressive than noted on the right.


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## msncoder (Jun 19, 2009)

Diane,
   You would code the Sotradecol injection as 36470 and the venogram would be 75822, 36012 (rt int iliac), & 36012 (lt int iliac). There is no CCI bundling edit when billing these together. 
Conscious sedation is bundled and unless your physician documents the medical necessity of the perm u/s images for jugular access then it is not billable either.


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