Are you prepared for the potential of declining reimbursement next year? CMS is once again targeting payments in the proposed PFS rule, which means the likelihood of less payment for your services even if they are performed and coded correctly. Did you know that as much as 30 percent of interventional radiology coding is lost in errors nationally? This area can be painfully challenging for many coders. Venous studies are one such modality within IR, analyzed by our experts, as an area loaded with common challenges and a ripe opportunity for committing errors. Here, we will explore some of the codes to fortify accurate understanding that will ultimately reinforce reimbursement and guard against compliance pitfalls.
Understanding Venous S&I Codes
- 75820 Venography, extremity, unilateral, radiological supervision and interpretation
- 75822 Venography, extremity, bilateral, radiological supervision and interpretation
Assign code 75820 for a unilateral extremity venogram or 75822 for a bilateral exam. What happens if both upper and lower extremities are examined? In this instance report the appropriate code twice. If bilateral non-selective extremity venograms are performed, 36005 would be assigned for each access and injection. Extremity venography may also be performed through selective catheterization, and in that case, 36011 and/or 36012 would be assigned instead of 36005. Understand that codes 75820 or 75822 also may be assigned during an exam to evaluate for female pelvic congestion.
Often the iliac, hypogastric and femoral veins are imaged as well as ovarian veins and extremity venography code(s) would be assigned as appropriate. Note that when any of those veins are imaged, imaging of the right ovarian vein would be included as part of the extremity imaging. A renal venography code would be assigned for imaging of the left gonadal vein – the ovarian vein in women or left testicular vein in men.
- 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. However, 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
When 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. 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
- 75842 Venography, adrenal, bilateral, selective, radiological supervision and interpretation
Codes 75840 and 75842 are 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
Understand that code 75860 is most commonly assigned for jugular venography, but it could also be assigned for venography of the petrosal or inferior sagittal sinus. Do not code 75860 for jugular venography during a central venous access procedure when the central catheter is subsequently placed through the same site. Code 75860 also should not be assigned for a coronary sinus injection.
Other Circumstances Including Hepatic Venography Coding
- 75870 Venography, superior sagittal sinus, radiological supervision and interpretation
- 75872 Venography, epidural, radiological supervision and interpretation
- 75880 Venography, orbital, radiological supervision and interpretation
First, understand that 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.
- 75885 Percutaneous transhepatic portography with hemodynamic evaluation, radiological supervision and interpretation
- 75887 Percutaneous transhepatic portography without hemodynamic evaluation, radiological supervision and interpretation
Code 75885 or 75887 is assigned along with code 36481 when the portal system is evaluated. How do the codes differ? The codes differ based on whether or not hemodynamic evaluation (pressure measurements) is (are) performed. Assign 75885 if pressure measurements are taken and documented, or 75887 if 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
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. Many coders may experience confusion with the term “wedge.” What does this actually indicate?
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” is another term of potential confusion. “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 CPT code 75889-52 be assigned.
These are not all the essential coding tips and rationale for interventional radiology knowledge and venous coding…
As service volumes rebound and every dollar of reimbursement counts more than ever, it’s imperative to make sure your CPT® coding is correct and compliant. Master more IR coding topics and break down the complexity with our expert-infused 2023 Venous Studies Interventional Radiology Coding webcast, live on Wednesday, October 11, 2023. This webcast is an essential training tool for both audio and visual learners.