# Venogram



## JGolamco (Nov 12, 2013)

Please help... am i coding this right?

Under sterile aseptic technique, using real-time ultrasound guidance, 22-gauge Chiba needle introduced into the right internal jugular vein. 5 French catheter placed. Guidewire could not be passed into the central circulation.

Contrast was injected and a venogram was performed.

Under sterile aseptic technique, using real-time ultrasound guidance, 22-gauge needle introduced into the left internal jugular vein. Guidewire could not be passed into the central circulation.

5 French catheter was placed and a diagnostic venogram was performed.


FINDINGS:
Right jugular venogram shows occlusion of the jugular-subclavian confluence and upper portion of the superior vena cava.

Collaterals are seen to drain along the posterior mediastinum.

Left jugular venogram shows occlusion of the jugular-subclavian confluence, with multiple collaterals draining toward the posterior mediastinum.

No opacification of superior vena cava which is presumably chronically occluded.


IMPRESSION:
Evidence of chronic bilateral SVC occlusion.

Port placement is not possible from either of the internal jugular veins.

I got:

36005-50
75827



Thank you!!!


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## dpeoples (Nov 13, 2013)

JoeG23 said:


> Please help... am i coding this right?
> 
> Under sterile aseptic technique, using real-time ultrasound guidance, 22-gauge Chiba needle introduced into the right internal jugular vein. 5 French catheter placed. Guidewire could not be passed into the central circulation.
> 
> ...



I would code:
36000-50
75860-LT
75860_RT

This is not and extremity study, and the svc is not imaged or interpreted except that it can't be seen. This is an evaluation of the carotids for central venous device placement.
With device placement, it is included and not separately billable. Without device placement, this can be coded and billed.

HTH


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## JGolamco (Nov 14, 2013)

As always, thank you Danny!


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## margaret fahy (Nov 15, 2013)

*venogram jugular*

Hi,
Wouldn't it be 36011 RT/LT or 36011,36011-59?


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## dpeoples (Nov 15, 2013)

margaret fahy said:


> Hi,
> Wouldn't it be 36011 RT/LT or 36011,36011-59?



Not with a direct puncture/access of the carotids. In fact, there is no specific code for injection of contrast into the carotids from a direct puncture, that is why I use 36000, instead of 36005 which is for extremities only.

HTH


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## margaret fahy (Nov 21, 2013)

*venogram Jugular*

So, is it 35004 because they couldn't pass the guidewire..either side?
Otherwise would it have been 36011?
Margie


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## Jim Pawloski (Nov 26, 2013)

margaret fahy said:


> So, is it 35004 because they couldn't pass the guidewire..either side?
> Otherwise would it have been 36011?
> Margie



36000 is introduction of needle or intracatheter, vein.  36100 is introduction of needle or intracatheter, carotid or vertebral artery.  So 36000-50 would be the needle placement in the veins.
HTH,
Jim Pawloski, CIRCC


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