Ask Dr. Z

We have a scenario that is frequently encountered in IR, and we need clarifications for coding the number of surgical fields and if diagnostic imaging is warranted. It is my understanding that billing for bilateral ovarian vein embolization is a grey zone, and we see difference in the recommendations regarding coding one time embolization (37241) or two separate surgical fields (37241, 37241-59). "Catheter was advanced into left renal and left and right ovarian veins with imaging (36012, 36011-59, 75833). Selective catheterization of ovarian veins and coil embolization with post imaging. Left ovarian venography showed reflux of contrast into the deep pelvic venous plexus with multiple para-uterine varicosities. Varicosity also extends into the vulvar region. Initial hand injection into the right gonadal vein demonstrated no reflux of contrast towards the pelvis. The patient was therefore placed in 15 deg of reverse. Injection revealed reflux of contrast into the deep ovarian vein with opacification of small para-uterine varicosities."