Ask Dr. Z

Hello, Would the codes 36010/75827/75820 be incorrect based on the documentation below? I thought the unlisted code 36299 for the jugular access because it is not documented that the catheter is in the vena cava. Should this be 75860 or is there enough to bill 75827/75820? Thank you in advance. PROCEDURE: LIMITED CENTRAL VENOGRAM. CLINICAL DATA: 46 YEAR OLD FEMALE STATUS POST ORTHOTOPIC HEART TRANSPLANT. INABILITY TO PASS GUIDEWIRE INTO RIGHT ATRIUM FOR CARDIAC BIOPSY THROUGH RIGHT INTERNAL JUGULAR VEIN. OPERATORS: AMULURU, MOLVAR. MODIFIER GC - THIS SERVICE HAS BEEN PERFORMED IN PART BY A RESIDENT, DR. AMULURU UNDER THE DIRECTION OF A TEACHING PHYSICIAN. DETAILS: AFTER DISCUSSION OF THE PROCEDURE, INCLUDING ITS RISK, BENEFITS AND ALTERNATIVES, INFORMED CONSENT WAS OBTAINED. PATIENT WAS PLACED SUPINE ON THE FLUOROSCOPIC IMAGING TABLE. THE RIGHT NECK WAS PREPPED AND DRAPED IN USUAL STERILE FASHION. THE RIGHT INTERNAL JUGULAR VEIN WAS ACCESSED WITH A 5-FRENCH MICROPUNCTURE KIT UNDER ULTRASOUND VISUALIZATION. CONTRAST INJECTION OF THE 5-FRENCH SHEATH DEMONSTRATED PATENT VISUALIZED RIGHT INTERNAL JUGULAR VEIN AND RIGHT BRACHIOCEPHALIC VEIN, WITHOUT SIGNIFICANT STENOSIS. WIDELY PATENT SVC. THE 5-FRENCH SHEATH WAS REMOVED AND HEMOSTASIS ACHIEVED WITH MANUAL PRESSURE. A STERILE DRESSING WAS APPLIED. THE PATIENT TOLERATED THE PROCEDURE WELL WITHOUT IMMEDIATE POSTPROCEDURAL COMPLICATION. IMPRESSION: PATENT RIGHT INTERNAL JUGULAR VEIN, RIGHT BRACHIAL CEPHALIC VEIN AND SVC.