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Bilateral Lower Extremity Venograms from Internal Jugular Approach

Date: Oct 22, 2014

Question:

For the following case, are codes 36012-50, 36005-59, 75822, and 75825 correct?

Using US guidance, a micropuncture needle access attempted into small irregular LT CFV (36005-59). Several attempts were made to pass a wire up through left iliac stents but were unsuccessful. Then access was from the right IJV down into the left SFV and right CFV with catheter placement (36012-50). We traversed entire length of existing iliac venous stents. Contrast injection digital subtraction LLE and left pelvic venogram were performed. Could not traverse beyond region of proximal left thigh due to significant venous irregularity. Catheter was pulled back and positioned in distal aspect of left iliac vein stents, and contrast injection pelvic venograms were performed to evaluate stent patency. Next, access was gained into right iliac vein with glide catheter and with resistance in expected region of right CFV. Could not advance beyond level of right femoral head. Contrast injection digital subtraction right pelvic venogram performed with catheter in right CFV (75822). Catheter was pulled up into central right common iliac vein, and then IVC venogram was performed (75825).

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