Wiki Code venogram as well as 77001??

[suela923@aol.com]

We are divided on how to bill this case. One of the girls say we can bill for venogram with a mod 52 but I think the venogram is included in the 77001. Any help is appreciated!! Thanks, Sue


Result Narrative

Right upper extremity central venogram; right upper extremity PICC line replacement under fluoroscopic guidance

History: Congestive heart failure, need IV PICC line for venous access. Malpositioned PICC. History of cardiomyopathy.

Technique: Timeout was performed. Skin over right upper arm was prepped and draped sterilely. 2% lidocaine used as a local anesthetic. Maximum sterile barrier technique was utilized. Existing PICC line was removed over a wire and a Berenstein catheter was advanced to the right subclavian vein. Venogram was performed. Catheter and wire were attempted to negotiate the existing occlusion but this was not successful. New 4-French single-lumen PICC, 35 cm in length, with 1 cm external was advanced to the central right subclavian vein. X-ray was obtained. No complications occurred.

Findings: There is a left-sided generator with AICD and pacemaker wires. Right arm PICC could not be advanced centrally over a wire. Right subclavian venogram shows occlusion of the central right subclavian vein and right brachiocephalic vein. Transcervical and transthoracic collaterals reconstitute the right and left brachiocephalic veins and SVC which appear patent. This occlusion could not be traversed with a wire and catheter. PICC line was placed in the right subclavian vein, with good blood return and excellent flushing.

 

[dpeoples]

We are divided on how to bill this case. One of the girls say we can bill for venogram with a mod 52 but I think the venogram is included in the 77001. Any help is appreciated!! Thanks, Sue


Result Narrative

Right upper extremity central venogram; right upper extremity PICC line replacement under fluoroscopic guidance

History: Congestive heart failure, need IV PICC line for venous access. Malpositioned PICC. History of cardiomyopathy.

Technique: Timeout was performed. Skin over right upper arm was prepped and draped sterilely. 2% lidocaine used as a local anesthetic. Maximum sterile barrier technique was utilized. Existing PICC line was removed over a wire and a Berenstein catheter was advanced to the right subclavian vein. Venogram was performed. Catheter and wire were attempted to negotiate the existing occlusion but this was not successful. New 4-French single-lumen PICC, 35 cm in length, with 1 cm external was advanced to the central right subclavian vein. X-ray was obtained. No complications occurred.

Findings: There is a left-sided generator with AICD and pacemaker wires. Right arm PICC could not be advanced centrally over a wire. Right subclavian venogram shows occlusion of the central right subclavian vein and right brachiocephalic vein. Transcervical and transthoracic collaterals reconstitute the right and left brachiocephalic veins and SVC which appear patent. This occlusion could not be traversed with a wire and catheter. PICC line was placed in the right subclavian vein, with good blood return and excellent flushing.

I agree with you. A venography is not appropriate for guidance for placement or replacement of a central catheter, with one access. A good arguement can be made occasionally when there is a separate access for the venography.

HTH

 

[margaret fahy]

I agree with Danny. One access...so no Venogram. If siite was abandoned and new site chosen, then you could bill for the Venogram with a 59 mod, as well as for the insertion at the new site.
Margie