Treatment of Accessory Vein

1. Treatment of Accessory Vein ASDIN Coding University

2. Methods of Treatment • Two methods for the treatment of an accessory vein have been described • Ligation • Percutaneous ligation • Surgical ligation • Embolization coil • These two methods share some codes in common, but there are codes that are also unique to each approach

3. Common Codes

4. Cannulation/Catheterization • Treatment of an accessory vein involves cannulation of the access (36147 for the first and +36148 if a second is required) • The procedure often requires selective catheterization of either a 1st (36011) or 2nd order vein (36012) (Refer to the unit of Cannulation/Catheterization for more detail on these codes)

5. Specific Codes

6. Vein Ligation • The common codes would be recorded as appropriate • The code that is recommended for vein ligation is 37607 • The descriptor for this code is – ligation or banding of angioaccess arteriovenous fistula • This is the recommended code for both surgical and percutaneous ligation • 37607 should only be used once, regardless of the number of vessels ligated or the method of ligation

7. Insertion of Embolization Coil • The procedures covered by the common codes play a major role with this approach to therapy • The specific code for insertion of an embolization coil is 37204 • The descriptor for this code is - transcatheter occlusion or embolization, percutaneous, any method, non-central nervous system, non-head or neck

8. Radiological Supervision & Interpretation • The supervision and interpretation code that goes with 37204 is 75894 • The descriptor for 75894 is - transcatheter therapy, embolization, any method, radiological supervision and interpretation

9. Placement of Multiple Coils • In some instances there is a single accessory vein which requires a single coil • However, there are instances in which more that one coil must be placed in order to accomplish the result • These later cases fall into one of two categories: • A single vein comes off of the fistula and then branches to create a single field of veins, because of the specific anatomy it may be necessary to coil the branches • An additional accessory vein(s) come off of the AVF and need(s) to be treated

10. Single Accessory Vein • Single vein – single coil – Single 37204 recorded

11. Multiple Accessory Veins • Multiple veins derived from AVF – multiple coils – multiple 37204 codes recorded

12. Single Field of Veins • Single field of veins - single vein that branches – multiple coils – single 37204 recorded

13. The Key To Coding Multiple Coil Placement • Each accessory vein that derives from the AVF gives rise to a field of veins • Each field of veins that is treated with a coil or with coils warrants only a single 37204 code regardless of how many coils the operator chooses to place

14. Post Coil Placement Angiogram • Unlike other post-procedure angiograms, it is possible to code for a follow-up angiogram following the placement of an embolization coil if medically indicated • The code for this procedure 75898 • The descriptor for this code is angiography through existing catheter for follow-up study for transcatheter therapy, embolization or infusion • As the descriptor indicates for this angiogram, performing it through the catheter that is in place (for insertion of the coil) is required

15. Use of Diagnostic and Therapeutic RS&I Codes Together • When a diagnostic RS&I code is used in association with a therapeutic RS&I code, a 59 modifier should be attached to the former • In the instance described here – an embolization coil is placed and then a post-coil angiogram via catheter is performed • The coding would be the codes for the coil placement, 37204 and 75894 (therapeutic RS&I), and the code for the angiogram, 75898-59 (diagnostic RS&I)

16. Important Note • This document is for informational purposes only and should serve as a guideline for appropriate coding. • The ultimate responsibility for correct coding /documentation remains with the provider of service.  • ASDIN makes no representation, warranty, or guarantee that this compilation of information is error-free, nor that the use of this guide will prevent differences of opinion or disputes with CMS or any other carrier. • ASDIN will bear no responsibility or liability for the results or consequences that may grow out of the use of this guidance.