Ask Dr. Z

This is an image-guided sclerotherapy of a right knee low flow vascular malformation. "Under direct ultrasound guidance, a 22 gauge needle was advanced through the anesthetized tissues and into the vascular malformation. An ultrasound image was recorded. Under fluoroscopy, hand injection of contrast confirmed position. The angiographic study of the malformation revealed filling of the dysmorphic irregular veins/venous lakes within the malformation in the lateral aspect of the femoral condyle. The malformation has two small draining veins at its proximal aspect emptying into the right popliteal vein, likely the genicular veins. Next the foam was injected into the low flow vascular malformation until filling of the draining veins was identified. There was good distribution of the sclerosing agent within the malformation..." With the new codes for 2014, we are pretty sure we would report this sclerotherapy with code 37241. But what, if anything, should we use for the needle access and angiographic study?