Ask Dr. Z

hello, I have a case where a patient has a duplicate vena vaca arising from the renal vein. I am thinking of coding everything twice my only concern is if i should code the duplicated vena-cava as 36010 or 36011 since it came from a selective renal vein. codes 36010,37620x2 75940 x2 75827 (as he found the duplicate vena cava via this study)for the additional vena cava i am not to sure. Here is the example: please advise as i am at a lost..thank you for your help The patient's right neck was prepped and draped using sterile technique. 1% lidocaine solution was used for local anesthesia. Under real-time ultrasound guidance, the right internal jugular vein was punctured using a 21-gauge needle and a 0.018 wire was passed into the inferior vena cava. The needle was then exchanged for a 5 French micropuncture catheter. Through the micropuncture catheter, a 0.035 stiff shaft Glidewire was advanced into the inferior vena cava and eventually into the left common iliac vein. The micropuncture catheter was exchanged for a 5 French pigtail catheter which was placed into the left common iliac vein. Then, inferior vena cavogram was performed. The inferior vena cavogram demonstrates a patent inferior vena cava. There is, however, a duplicated inferior vena cava present extending from the left common iliac vein to the left renal vein. There is intraluminal thrombus seen within the left common iliac vein extending slightly into the inferior vena cava as well as extensive amount of thrombus within the duplicated inferior vena cava. Then, over a stiff shaft Glidewire the pigtail catheter was exchanged for a 9 French vascular introducer. The vascular introducer was placed within the intrarenal inferior vena cava and a Gunther-Tulip filter was advanced and deployed within the infrarenal inferior vena cava above the thrombus within the inferior vena cava. Then selective catheterization of the left renal vein was performed using a Cobra 2 catheter and the vascular introducer was advanced over the Cobra 2 catheter into the left renal vein and eventually into the duplicated inferior vena cava. A venogram was then performed which again demonstrates thrombus within the duplicated inferior vena cava and a patent left renal vein with no evidence of intraluminal thrombus. There appeared to be a small amount of space within the superior aspect of the duplicated inferior vena cava where a filter could be placed without protruding into the left renal vein. Through the vascular introducer, a second Gunther-Tulip filter was advanced and deployed within the duplicated inferior vena cava above the thrombus within the duplicated inferior vena cava. The filter did not protrude into the left renal vein. The vascular introducer was then removed. Complete and immediate hemostasis was achieved