Treatment of Accessory Vein

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Treatment of Accessory Vein

• ASDIN Coding University

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Methods of Treatment

• Two methods for the treatment of an accessory
  vein have been described
• Ligation
• Percutaneous ligation
• Surgical ligation
• Embolization coil
• These two methods share some codes in common, but
  there are codes that are also unique to each
  approach

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Common Codes
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Cannulation/Catheterization

• Treatment of an accessory vein involves
  cannulation of the access (36147 for the first
  and 36148 if a second is required)
• The procedure often requires selective
  catheterization of either a 1st (36011) or 2nd
  order vein (36012)
• (Refer to the unit of Cannulation/Catheterization
  for more detail on these codes)

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Specific Codes
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Vein Ligation

• The common codes would be recorded as appropriate
• The code that is recommended for vein ligation is
  37607
• The descriptor for this code is ligation or
  banding of angioaccess arteriovenous fistula
• This is the recommended code for both surgical
  and percutaneous ligation
• 37607 should only be used once, regardless of the
  number of vessels ligated or the method of
  ligation

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Insertion of Embolization Coil

• The procedures covered by the common codes play a
  major role with this approach to therapy
• The specific code for insertion of an
  embolization coil is 37204
• The descriptor for this code is - transcatheter
  occlusion or embolization, percutaneous, any
  method, non-central nervous system, non-head or
  neck

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Radiological Supervision Interpretation

• The supervision and interpretation code that goes
  with 37204 is 75894
• The descriptor for 75894 is - transcatheter
  therapy, embolization, any method, radiological
  supervision and interpretation

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Placement of Multiple Coils

• In some instances there is a single accessory
  vein which requires a single coil
• However, there are instances in which more that
  one coil must be placed in order to accomplish
  the result
• These later cases fall into one of two
  categories
• A single vein comes off of the fistula and then
  branches to create a single field of veins,
  because of the specific anatomy it may be
  necessary to coil the branches
• An additional accessory vein(s) come off of the
  AVF and need(s) to be treated

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Single Accessory Vein

• Single vein single coil Single 37204 recorded

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Multiple Accessory Veins

• Multiple veins derived from AVF multiple coils
  multiple 37204 codes recorded

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Single Field of Veins

• Single field of veins - single vein that branches
  multiple coils single 37204 recorded

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The Key To Coding Multiple Coil Placement

• Each accessory vein that derives from the AVF
  gives rise to a field of veins
• Each field of veins that is treated with a coil
  or with coils warrants only a single 37204 code
  regardless of how many coils the operator chooses
  to place

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Post Coil Placement Angiogram

• Unlike other post-procedure angiograms, it is
  possible to code for a follow-up angiogram
  following the placement of an embolization coil
  if medically indicated
• The code for this procedure 75898
• The descriptor for this code is angiography
  through existing catheter for follow-up study for
  transcatheter therapy, embolization or infusion
• As the descriptor indicates for this angiogram,
  performing it through the catheter that is in
  place (for insertion of the coil) is required

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Use of Diagnostic and Therapeutic RSI Codes
Together

• When a diagnostic RSI code is used in
  association with a therapeutic RSI code, a 59
  modifier should be attached to the former
• In the instance described here an embolization
  coil is placed and then a post-coil angiogram via
  catheter is performed
• The coding would be the codes for the coil
  placement, 37204 and 75894 (therapeutic RSI),
  and the code for the angiogram, 75898-59
  (diagnostic RSI)

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Important Note

• This document is for informational purposes only
  and should serve as a guideline for appropriate
  coding.
• The ultimate responsibility for correct coding
  /documentation remains with the provider of
  service. 
• ASDIN makes no representation, warranty, or
  guarantee that this compilation of information is
  error-free, nor that the use of this guide will
  prevent differences of opinion or disputes with
  CMS or any other carrier.
• ASDIN will bear no responsibility or liability
  for the results or consequences that may grow out
  of the use of this guidance.