Cardiology Coding Alert

Question: How should I code the following renal venogram procedure: After cannulating the right common femoral vein, our cardiologist advanced a guidewire into the inferior vena cava and used a pigtail catheter to obtain an inferior vena cavogram. He next cannulated the left interior iliac vein and performed a selective left internal iliac venogram. He inserted a catheter into the left renal vein, advanced a guidewire, and advanced the catheter to obtain a distal left renal venogram. Missouri Subscriber Answer: For the selective catheterization of the left interior iliac vein, report 36011 (Selective catheter placement, venous system; first order branch [e.g., renal vein, jugular vein]). If the physician documents the catheterization findings, report 75831-26 (Venography, renal, unilateral, selective, radiological supervision and interpretation; professional component). If the physician performed selective catheterization of the left renal vein, report 36011 and append modifier -59 (Distinct procedural service) to indicate that this catheterization is a separate and distinct procedure involving the left renal vein. In addition, you should report 75831-26 and append modifier -59 if the documentation supports the use of this code by describing the findings of the left renal vein venogram. You would not report the inferior vena cavogram separately, according to CPT guidelines. Selective vascular catheterization includes introduction and all lesser-order selective catheterizations used in the approach.