Question:

Is embolization for pelvic congestion considered one or two surgical fields? Also, how do I code for the diagnostic venograms that are performed during pelvic/ gonadal venography?

Answer:

The answer depends on what veins are embolized to achieve retrograde occlusion of the pelvic venous system. If bilateral gonadal veins are embolized in the distal pelvis, closer to where the left and right systems meet, this may be considered one surgical field (analogous to an embolization for uterine fibroids) and 37241 would be reported once. However, if the central outflow portion of the bilateral gonadal veins are embolized, this would be considered two separate surgical fields (analogous to a bilateral renal artery embolization) and 37241 should be reported twice. When performing venography assessing female pelvic congestion syndrome, there is often selective catheterization and study of the iliac, hypogastric, and sometimes femoral veins because these patients often have vulvar, labial, thigh and/or gluteal varices as well as pelvic symptoms. This procedure is most correctly coded as extremity venography (75820–75822) with the appropriate catheterization codes. Selective left gonadal venography should be coded as 36012 and 75831 since the left gonadal vein in males and females is typically a branch of the left renal vein. Selective right gonadal venography is more difficult to code since the right gonadal vein typically arises directly from the inferior vena cava (therefore a first-order selective code 36011) and does not typically include a renal venogram; therefore, it does not have a corresponding RS&I code.

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