Ask Dr. Z

For the following procedure, would you recommend adding code 36000 (vs. a different CPT vs. no CPT) for the attempted/failed left subclavian vein access?

"The patient presented for an ICD upgrade. A left subclavian venogram was performed, demonstrating patency of the distal subclavian vein, but possible occlusion after crossing the clavicle. The decision was made to attempt the upgrade from the left side, but if occlusion was encountered, the LV lead would be placed via the right subclavian vein and tunneled over to the left-sided pocket. After the ICD pocket was opened and the existing generator removed, the left subclavian vein was accessed with a micropuncture needle under fluoroscopic guidance. However, the micropuncture wire could not be advanced beyond the clavicle due to occlusion. The right subclavian vein was then accessed successfully, and the procedure continued. The LV lead was tunneled across the chest to the left-sided ICD pocket."