2. Treatment of Accessory Vein ASDIN Coding University 1

3. 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 2

4. Common Codes 3

5. 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) 4

6. Specific Codes 5

7. 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 6

8. 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 7

9. 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 8

10. 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 9

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

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

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

14. 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 13

15. 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 14

16. Use of Diagnostic and Therapeutic RS&I Codes Togethe r 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) 15

17. 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. 16