Wiki Would 37197 include diagnostic venography?

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ablythe

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I know 37193 (IVC filter retrieval) includes diagnostic venography but would 37197 (removal of foreign material) also include diagnostic venography? I have never used this new code, and there is a difference of opinion in my office. The code descriptions for 37193 and 37197 are enough different from each other that I think 37197 might not include the diagnostic.

Thanks so much,

A. Blythe, CPC, CCC
 
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Retrieval codes

It is my understanding that this code is only for the retrieval and does not include a diagnostic venogram. You can code for the catheter placement and venogram in addition to the retrieval
Ann CIRCC
 
ablythe said:
I know 37193 (IVC filter retrieval) includes diagnostic venography but would 37197 (removal of foreign material) also include diagnostic venography? I have never used this new code, and there is a difference of opinion in my office. The code descriptions for 37193 and 37197 are enough different from each other that I think 37197 might not include the diagnostic.

Thanks so much,

A. Blythe, CPC, CCC
Click to expand...

You can charge for a TRUE diagnostic venography as long as medical necessity is clearly documented.

Can you provide a report?

:)
 
I am so new to billing and coding this. Any help would be sooo much appreciated as how to bill.

Pre-op. Diagnosis:
1.Chronic embolism and thrombosis of inferior vena cava - I82.221
Post-op. Diagnosis:
1.Chronically occluded bilateral iliac veins and IVC
Operation:
1.Ultrasound-guided access into the bilateral greater saphenous veins and the right internal jugular vein with permanent recording and reporting
2.Pelvic venogram and inferior vena cavogram
3.Intravascular ultrasound of bilateral iliac veins and inferior vena cava
4.Endovascular retrieval of inferior vena cava filter
5.Stent placement within the infrarenal IVC, left common iliac vein, right common iliac vein, right external iliac vein, and right common femoral vein
Anesthesia:
Local anesthesia with 1% lidocaine was administered at the access site. Anesthesia was provided by anesthesiologist Dr. Nguyen.
Indications:
Post-thrombotic syndrome. History of 3 year old IVC filter. Known occlusion of IVC and bilateral iliac veins.
Details of Procedure:
Informed consent for the procedure including risks, benefits and alternatives was obtained and time-out was performed prior to the procedure. The site was prepared and draped using maximal sterile barrier technique including cutaneous antisepsis.

Initial scout images showed a tilted Celect IVC filter.

The patient was positioned supine on the angiography table. Using ultrasound guidance, the patent bilateral greater saphenous veins were percutaneously accessed using a micropuncture needle. Permanent images were stored. 10 French sheaths were introduced at each access site. Contrast was injected and pelvic venogram performed. This revealed complete chronic occlusion of the right external and common iliac veins. The left external iliac vein was patent, without stenosis. Numerous pelvic, paravertebral, and abdominal wall collaterals were present. There was chronic occlusion of the infrarenal IVC at the level of the filter and extending caudally. The nose and hook of the filter was embedded within the right lateral caval wall. The struts extended outside of the cava. The inferior vena cava cephalad to the filter was patent.

Using ultrasound guidance, the patent right internal jugular vein was percutaneously accessed using a micropuncture needle. A permanent image was stored. Using this access, a 16 French sheath was placed. The tip of the sheath was placed at the level of the nose of the IVC filter. An endobronchial forceps device was then used to free the nose and hook of the filter from the caval wall. The nose of the filter was then grabbed with the forceps and the filter freed from the cava by advancing the sheath over the filter. The filter was then pulled out of the sheath. Examination of the filter revealed it to be intact.

Next, using a wire and catheter, the right iliac vein and IVC occlusion was crossed. Contrast injection in the IVC confirmed successful crossing. The left external iliac vein occlusion was then crossed via the left groin access with a wire and catheter. Contrast injection in the IVC confirmed successful crossing.

Parallel balloon angioplasty of the infrarenal IVC was then performed using 12 mm balloons. 12 mm balloon angioplasty of the left common iliac vein and right common iliac, external iliac, and common femoral veins was next performed.

Next, double barrel 14 mm Zilver Vena stents were deployed within the infrarenal IVC with extension across each common iliac vein. An additional 14 mm Zilver Vena stent was deployed within the right external iliac and common femoral veins. All stents were profiled with the 12 mm balloons.

Post stent reconstruction venograms showed excellent brisk flow throughout both iliac veins and within the IVC, without residual stenosis and with resolution of collateral filling.

Sheaths and wires were removed and hemostasis achieved using manual compression. Sterile dressings were applied.
Specimens:
None.
Complications:
None.
Findings:
Summary:

Chronic infrarenal IVC and bilateral iliac venous occlusions secondary to indwelling IVC filter. The IVC filter was successfully retrieved and iliocaval stent reconstruction performed, as described above.

Plan:

Start Eliquis 2.5 mg BID and aspirin 81 mg daily. Follow up in 2 weeks.
Notes:
Total fluoroscopy time: 15 minutes
Procedure Codes:
1.76937 US GUIDE, VASCULAR ACCESS. Units: 3.00. Modifiers: 26, 59
2.37193 REM ENDOVAS VENA CAVA FILTER. Modifiers: 22
3.37238 OPEN/PERQ PLACE STENT SAME, Inferior vena cava.
4.37239 OPEN/PERQ PLACE STENT EA ADD, Left common iliac vein.
5.37239 OPEN/PERQ PLACE STENT EA ADD, Right common iliac vein.
6.37239 OPEN/PERQ PLACE STENT EA ADD, Right external iliac vein.
7.37239 OPEN/PERQ PLACE STENT EA ADD, Right common femoral vein.
8.G9500 RADIATION EXPOSURE INDICES DOC.
9.36005 INJECTION EXT VENOGRAPHY.
10.75820 VEIN X-RAY, ARM/LEG.
11.37252 INTRVASC US NONCORONARY 1ST.
12.37253 INTRVASC US NONCORONARY ADDL.
 
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