Neurosurgery Coding Alert

Question: Our surgeon performed a transvenous venogram of the left subclavian vein and left external jugular vein with coil embolization of external jugular vein. This was done for pulsatile tinnitus, left ear. Would I be correct in assigning 36012 and 75860 for the jugular vein catheterization and would I assign another 36012 and 75860 for the subclavian vein catheterization? And, would I assign 61626 for the embolization along with 75894 and 75898?

Alaska Subscriber

Answer: Code 36012 (Selective catheter placement, venous system; second order, or more selective, branch [e.g., left adrenal vein, petrosal sinus]) is for second order vein, such as the petrosal vein and code 75860 (Venography, venous sinus [e.g., petrosal and inferior sagittal] or jugular, catheter, radiological supervision and interpretation) is for the radiological supervision and interpretation of that venogram. Neither of these second order vessel procedures were described in your scenario. Codes that you should report are based on the highest order of vessel reached. You do not code separately for the lesser order vessels. However, these codes are only for catheter placement and venography and do not describe embolization.

Code 61626 (Transcatheter permanent occlusion or embolization [e.g., for tumor destruction, to achieve hemostasis, to occlude a vascular malformation], percutaneous, any method; non-central nervous system, head or neck [extracranial, brachiocephalic branch]) is the definitive embolization code and you may also report 75894 (Transcatheter therapy, embolization, any method, radiological supervision and interpretation) for radiological supervision and interpretation, if performed. You may need to append modifier 26 for the professional component if your physician does not own the equipment used.

Code 61626 is for ‘transcatheter therapy’ and is inclusive of catheterization.

Note: Codes 61623-61626 codes all are used for transcatheter occlusion/embolization therapy. Code 61626 is for occlusion or embolization of a vascular malformation. The code descriptor also specifies “….to occlude a vascular malformation.” The procedure includes the necessary fluoroscopic guidance.