# Need expert opinion on venogram



## deeva456 (Aug 10, 2011)

My new EP doc would like to bill for axillary vein venogram during an ICD implantation. Can this be separately billed? Here is part of the report.  Are there rules or polices that if a lesion or stenosis is found, does it have to be treated or addressed?  

Your help is appreciated. 

Thank you, 
Dolores, CCC CPC


A left subclavian venogram was performed and using this as a guide,
the left axillary venogram was cannulated using the modified
Seldinger technique. Considerable difficulty was encountered in
advancing a wire. A 6-French dilator was then used to guide the
Slime/Terumo wire across several areas of *moderate to severestenosis in the left brachiocephalic vein*. Subsequently, an
8-French long sheath was advanced over this wire into the right
atrium through which a St. Jude Medical model 7122, 60-cm active
fixation lead, serial number AHG017965 was advanced to the right
ventricular apex and secured under fluoroscopic guidance.


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## krisfelty (Aug 12, 2011)

It is not billable if used as a guide, is what I have always known it to be.


Kris Felty, CPC, CCC


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