# intraoperative venogram



## nbrau (May 2, 2011)

Any advice would be greatly appreciated 

I code for an ASC we had a patient come in for for varicocele ligation and the surgeon also performed an intraoperative venogram.  

I coded 55530 for the varicocele excision, however I an stumped as to what to code for the venogram.  See OP note below.  THANKS!

PROCEDURE: The patient was given appropriate general anesthetic. A time-out was performed identifying the patient for a left varicocele and venogram. Marcaine was injected into the intended site of incision halfway between the anterior iliac spine and pubic tubercle. This incision was carried down ligating the superficial circumferential vein and dividing the Scarpa fascia. Once the external oblique was identified, the external ring was incised along the direction of its fibers. The cord was identified entering the external ring and was freed up with blunt and sharp dissection posteriorly to allow right-angle clamp and Penrose to be placed around this to lift it out of the pelvis. The external spermatic fascia was incised anteriorly. The vas deferens was identified posteriorly along with the testicular artery. It could be seen pulsating adjacent to the vas deferens. A bulk of veins was noted anterior. These were sharply dissected from the remaining tissue to allow some of the lymphatics to be patent. The clump of veins was then clamped median cephalad, and a venotomy was performed in the larger vein with a 5-French feeding tube being then passed down caudally; 50% diluted Omnipaque was injected, about 5 mL total, under fluoroscopic observation. The veins were seen to fill in the scrotal area, but there did not appear to be any blood flow cephalad above clamp. Subsequently, the feeding tube was removed. The remainder of the veins were ligated and sent as a block mass for pathology to review, describe and confirm venous tissue. The spermatic fascia was closed over the anterior portion of the cord. Cord was replaced into the inguinal canal, and the external oblique fascia was closed with a running 2-0 Vicryl carefully avoiding the ilioinguinal nerve. The Scarpa fascia was closed with the same, and the skin with a running 3-0 Monocryl. Steri-Strips were applied along with a sterile dressing. The patient tolerated the procedure well and was returned to recovery for observation.


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