Ask Dr. Z

Can we bill the IVC venography (75825-26) with ASD closure when there is abnormal anatomy or would this be considered part of 93580 for placing the device?

"A 27 mm Gore Cardioform ASD Occluder was selected and prepared on the back table per the manufacturer's specifications. Through the right femoral sheath sheath, the device was attempted to be advanced, but could not track within the IVC to the right atrium. Therefore, we modified a Mullins sheath by cutting it to shorten it so a gore device would advance out the tip.

With the ice catheter positioned in the inferior vena cava, a hand injection was performed in the right common iliac vein through the femoral sheath. This again highlights the abnormal course of the inferior vena cava, running along the left side of the vertebral bodies before coursing rightward at the level of the liver.

Saved fluoroscopy demonstrates the initial attempted device deployment. This attempt demonstrates that the device pulls through from the left atrium into the right atrial side."