Treatment of Accessory Vein
ASDIN Coding University
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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
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Common Codes
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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)
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Specific Codes
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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
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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
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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
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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
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Single Accessory Vein
• Single vein – single coil – Single 37204 recorded
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Multiple Accessory Veins
• Multiple veins derived from AVF – multiple coils –
multiple 37204 codes recorded
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Single Field of Veins
• Single field of veins - single vein that branches –
multiple coils – single 37204 recorded
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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
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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
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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)
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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.
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