# Azygos Vein - The right and left azygos veins were catherized



## arleneg527 (May 21, 2010)

The right and left azygos veins were catherized as well as the entire upper extremity venogram.

I got 36012,36012 and 75822 for the bilateral extremity venogram.  The Dr. says I should add 75774.  Is he correct or is it included in the 75822?

Thank you.


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## dpeoples (May 27, 2010)

arleneg527 said:


> The right and left azygos veins were catherized as well as the entire upper extremity venogram.
> 
> I got 36012,36012 and 75822 for the bilateral extremity venogram.  The Dr. says I should add 75774.  Is he correct or is it included in the 75822?
> 
> Thank you.




That is a million dollar question. The Dr considers this an additional after basic exam hince 75774, but that can only be argued if he clearly documents both (basic and additional) injection procedures.

However, the full definition of 75774 says " *angiography*, selective, additional after basic..." This is not an "angiography" but a "venography". The definition is important. I do not code additional after basic venographies for this reason. 

Personally, I would like to see the powers that be change the definition to something like   Angiography/Venograpy, selective, additional after basic, or add a code (maybe 75899) for an additional venography.

IMO, I think you need to decide if you should code this, and be consistent whatever you decide.

HTH


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## Jim Pawloski (May 28, 2010)

dpeoples said:


> That is a million dollar question. The Dr considers this an additional after basic exam hince 75774, but that can only be argued if he clearly documents both (basic and additional) injection procedures.
> 
> However, the full definition of 75774 says " *angiography*, selective, additional after basic..." This is not an "angiography" but a "venography". The definition is important. I do not code additional after basic venographies for this reason.
> 
> ...




If you look up the term "angio", the word angio means vessle.  So a Lymphangiogram is looking at the lymph vessles.  So the term angiogram is imaging of a vessle, either venous/ arterial/ or lymph.   So you can use this code for additional imaging in venous or arterial.

HTH,
Jim Pawloski, CIRCC, R.T.(R)(CV)


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## sbicknell (May 28, 2010)

I agree with Jim but want to mention.........

_Angiography, selective, each additional vessel studied after basic examination, radiological supervision and interpretation_

The 75774 is a selective procedure. If the documentation clearly states what vessels he did the additional selections then he can code each vessel that he did the additional select

But, "_as well as the entire upper extremity venogram_" leaves open a lot of questions ie right and left, right or left, which specific vessels etc. The documentation must be specific on where the cath was selectively placed each time


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## arleneg527 (Jun 3, 2010)

The Dr. told me that there is only 1 azygos vein, and we do code 75774 when is is performed.  That is how we have started to bill it.


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## sbicknell (Jun 3, 2010)

I don't know what you are doing and your last posting seems to contradict your intial posting. But just to be clear...........

If your Doc is doing an upper extremity angio and an Azygos angio, I don't see how you would code 75774, selective additional views of vessel. You're not on the same vascular systems. The Azygos runs up the andomen and appears to be separate from the vessels of the upper extremity. Someone please educate me on this if I am incorrect

But as far as coding the 75774, you have to be on that vascular family, doing an intial angio before you can code the 77574 of additional selective of that vascular family

Example: angio of aorta with bilateral run-off of both legs. Then additional selective angio views of the SFA. Then you can code the 75774 in addition to the 75630 (plus whatever 3624x placement codes)

_The azygos vein (v. azygos; vena azygos major) begins opposite the first or second lumbar vertebra, by a branch, the ascending lumbar vein; sometimes by a branch from the right renal vein, or from the inferior vena cava. It enters the thorax through the aortic hiatus in the diaphragm, and passes along the right side of the vertebral column to the fourth thoracic vertebra, where it arches forward over the root of the right lung, and ends in the superior vena cava, just before that vessel pierces the pericardium._


Here is another paste:

_Angiography Add-On Code 75774
Code 75774 (Angiography, selective, each additional vessel studied after basic examination, radiological supervision and interpretation) is reported when an additional selective angiography study within the same anatomic area as the initial vessel is studied. 
Per CPT, code 75774 is an add-on code, which means it must be reported in addition to the S&I code for the service provided for the initial angiography. Therefore, the appropriate S&I code would always be reported first for the vessel studied. The code descriptor also specifies that the additional study must be selective. 
So, either the catheter would need to be manipulated through a fork in the arterial pathway while moving away from the aorta or, after entering the aorta, the catheter would be manipulated into a vascular family that is different from the one initially accessed. 
If a selective catheterization is done in a higher order branch after the basic study and a more specific code is available, do not report code 75774. Instead report the specific code for the procedure._


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## arleneg527 (Jun 10, 2010)

Sbicknell,

I have never coded a study of the azygos vein before, so I am not sure what the S & I code would be, that's why I was hesitant in the beginning to code 75774. The Dr. also told me that there is only 1 azygos vein. Do you have any information regarding that, or can you direct me in the right direction so I can show the Dr. some information on this, as he is insistant on coding 75774?  He says this is a relatively new procedure and I would like to start coding it correctly.

Thank you.


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## dpeoples (Jun 10, 2010)

Jim Pawloski said:


> If you look up the term "angio", the word angio means vessle.  So a Lymphangiogram is looking at the lymph vessles.  So the term angiogram is imaging of a vessle, either venous/ arterial/ or lymph.   So you can use this code for additional imaging in venous or arterial.
> 
> HTH,
> Jim Pawloski, CIRCC, R.T.(R)(CV)



I used to subscribe to this reasoning but have changed my mind because:

A) There are different code categories for Angiography (75600-75791), Lymphangiographies (75801-75810) and Venographies (75820-75891). The cpt code 75774 is included only in the first set of codes.

B) As an additional after basic, selective, code 75774 would need a corresponding catheter selection code. Under the description of the code see the note (for catheter selection  see codes 36215-36248). The selection codes do not include venous selection (36000-36012).

That is *my* reason for not coding this way, but I certainly see why some coders do. 

As for coding a venography of the Azygos Vein, after doing more research I think it should be unlisted 76499. 

So, this is either a great discussion or a can-o-worms, not sure which just yet.

HTH


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## Jim Pawloski (Jun 10, 2010)

dpeoples said:


> I used to subscribe to this reasoning but have changed my mind because:
> 
> A) There are different code categories for Angiography (75600-75791), Lymphangiographies (75801-75810) and Venographies (75820-75891). The cpt code 75774 is included only in the first set of codes.
> 
> ...


Hi Danny,
I lean towards the can of worms.  I also like the definition of the Azygos vein, so I think the upper part of the vein could be catheterized by accident, but it does not make sense.  As to 75774, I agree with the part of the catheter being moved to another vessel, then additional imaging to be done for 75774.

Have a good weekend,
Jim Pawloski, CIRCC


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## arleneg527 (Jun 13, 2010)

Thanks for all the replies.  The Dr. thinks it should be coded and wants it coded as 75774.  He has been doing a lot of these lately.

I will be sitting the CIRCC exam in October, so I welcome all the help and information I an get. 

Thank you.


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