Interventional radiology is a maze of complexity and challenges, with some areas carrying more risk than others. Our experts have flagged venous S&I coding as an area that experiences an exceptional amount of confusion and incorrect coding. Accurate reporting of venous supervision and interpretation (S&I) codes is essential for capturing the full scope of the procedure while avoiding coding errors that can lead to missed reimbursement and create compliance vulnerability. These codes present several challenges, including distinguishing between unilateral and bilateral studies, determining when selective versus non-selective catheterization affects code assignment, recognizing when imaging is included in another procedure, and differentiating codes based on the specific venous territory examined or whether hemodynamic evaluation is performed. From extremity and caval venography to renal, adrenal, jugular, portal, and hepatic studies, understanding the documentation and coding requirements for each service is critical to selecting the appropriate S&I code and accurately reflecting the work performed. By examining the details, coders can improve accuracy while reducing the risk of errors, denials, and underpayment.
Venturing into Venous Coding
When reporting extremity venography, coders must first determine whether the examination is unilateral or bilateral. CPT® 75820 is assigned for a unilateral extremity venogram, while CPT 75822 is reported when the examination is bilateral. When both the upper and lower extremities are examined, the appropriate venography code should be assigned twice to reflect the additional examination.
Selection gets even more complicated depending on how the venography is performed. For bilateral non-selective extremity venograms, CPT 36005 is assigned for each access and injection. However, when extremity venography is performed through selective catheterization, CPT 36011 and/or 36012 should be reported instead of 36005. Understanding whether the study is unilateral or bilateral and whether the catheterization is non-selective or selective is the key to unlocking accurate reporting.
- 75820 Venography, extremity, unilateral, radiological supervision and interpretation
- 75822 Venography, extremity, bilateral, radiological supervision and interpretation
Codes 75820 and 75822 may also be assigned during examinations performed to evaluate female pelvic congestion. These studies may involve imaging of the iliac, hypogastric, and femoral veins, as well as the ovarian veins, with the appropriate extremity venography code(s) assigned based on the veins examined. When these veins are imaged, the right ovarian vein is included as part of the extremity imaging. However, coders should be aware that imaging of the left gonadal vein requires a renal venography code, whether it is the left ovarian vein in women or the left testicular vein in men. Missing this nuance can derail reporting. Correctly identifying the specific veins imaged is therefore essential to selecting the appropriate venography codes.
- 75825 Venography, caval, inferior, with serialography, radiological supervision and interpretation
75827 Venography, caval, superior, with serialography, radiological supervision and interpretation
Codes 75825 and 75827 are assigned for imaging of the IVC or SVC. Be aware that these codes should not be assigned for imaging during placement, repositioning, or removal of a vena cava filter.
- 75831 Venography, renal, unilateral, selective, radiological supervision and interpretation
- 75833 Venography, renal, bilateral, selective, radiological supervision and interpretation
In the scenario that one or both renal veins is/are catheterized for venography, the imaging is coded with 75831 for a unilateral study and 75833 for a bilateral study. One aspect that may trip up coders is determining what is included in the coding and does not need to be reported separately. Because the left gonadal (ovarian or testicular) vein is normally a branch of the left renal vein, imaging of that vein would be included in 75831.
- 75840 Venography, adrenal, unilateral, selective, radiological supervision and interpretation
Code 75840 is assigned for selective adrenal vein imaging. Do not assign one of these codes if the adrenal vein(s) are not selectively catheterized.
- 75860 Venography, venous sinus (e.g., petrosal and inferior sagittal) or jugular, catheter, radiological supervision and interpretation
Code 75860 is most commonly assigned for jugular venography, although it may also be reported for venography of the petrosal or inferior sagittal sinus. However, an important coding distinction applies when jugular venography is performed during a central venous access procedure: do not report 75860 when the central catheter is subsequently placed through the same access site. Likewise, 75860 should not be assigned for a coronary sinus injection. Understanding the specific venous structure being evaluated and the circumstances surrounding the procedure is essential for accurate reporting.
Certain codes are rarely used, increasing the opportunity for errors, but when they do arise, knowing the nuances can make all the difference. Codes 75870, 75872, and 75880 are infrequently performed procedures, or are performed as part of another major procedure and therefore not separately coded. For instance, an epidural venogram during a kyphoplasty procedure is included in the kyphoplasty code and not separately coded.
- 75870 Venography, superior sagittal sinus, radiological supervision and interpretation
- 75872 Venography, epidural, radiological supervision and interpretation
- 75880 Venography, orbital, radiological supervision and interpretation
Pinpointing Portography and Hepatic Venography
Code 75885 or 75887 is assigned along with code 36481 when the portal system is evaluated. What are the key components that differentiate reporting? The key distinction is whether or not hemodynamic evaluation (pressure measurements) is performed. Assign 75885 if pressure measurements are taken and documented, or 75887 if not.
- 75885 Percutaneous transhepatic portography with hemodynamic evaluation, radiological supervision and interpretation
- 75887 Percutaneous transhepatic portography without hemodynamic evaluation, radiological supervision and interpretation
Note that hepatic venography codes 75889 and 75891 are also differentiated by whether or not pressure measurements are taken and documented during venography. Assign 75889 when the measurements are documented and 75891 when they are not.
- 75889 Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation
- 75891 Hepatic venography, wedged or free, without hemodynamic evaluation, radiological supervision and interpretation
Accurate terminology can influence the decision to code correctly or risk errors. Questions can arise around specific terminology within the code descriptors. The term “wedged” indicates the technique of inflating a balloon and wedging it in the hepatic vein to temporarily occlude it so that pressure is equalized throughout the blood in that vein. “Free” indicates that the blood was flowing freely when the venography was performed and/or pressures measured. When a catheter is placed into the hepatic vein and pressures are obtained, but no imaging is performed, it is recommended that CPT code 75889-52 be assigned.
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