Cardiology Coding Alert

Question: Can I bill a venogram with a CRT-D?


Idaho Subscriber

Answer: No, you should include the venogram in +33225 (Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of pacing cardioverter-defibrillator or pacemaker pulse generator [including upgrade to dual chamber system] [list separately in addition to code for primary procedure]).
 
Rationale: The National Correct Coding Initiative includes 75820 (Venography, extremity, unilateral, radiological supervision and interpretation) and 36005 (Injection procedure for extremity venography [including introduction of needle or intracatheter]) with pacemaker and implantable cardioverter defibrillator procedures. Additionally, COT considered the work of placing the left ventricular lead during the development of this code.

Note: Earlier this year, Medicare expanded its coverage of cardiac resynchronization therapy devices (CRT-D) for all patients with Class IV heart failure who meet the current CMS coverage requirements. The rationale for this change is that those patients would likely improve their condition to Class III with this device. (See "Forget Appeals and Forego Denials With New ICD Criteria" in the March 2005 Cardiology Coding Alert.)

You Be the Coder and Reader Questions were prepared with the assistance of Jim Collins, ACS-CA, CHCC, CPC, CEO of the Cardiology Coalition and compliance manager for several cardiology groups around the country; and reviewed by Jerome Williams Jr., MD, FACC, a cardiologist with Mid Carolina Cardiology in Charlotte, N.C.