Ask Dr. Z

I'm hoping you can shed some light on how to handle situations where the left innominate vein is selectively catheterized and imaged for evaluation of veno-venous collaterals, but none are found. It seems that codes 36011 and 75820 would be appropriate in this case, but we're uncertain because this yields more RVUs than if collaterals were found and selected for additional imaging (remove 36011, add 93587). Are codes 93587 and 93588 meant for use when selective venous imaging is done to evaluate for collaterals (whether found or not), or are they only used when collateral vessels themselves are selectively entered and imaged? And if the latter, how do I explain to my doctors why they receive fewer RVUs for performing a higher order level of venous selectivity and imaging?