CPT® Code 75842

Official Description

Venography, adrenal, bilateral, selective, radiological supervision and interpretation

Common Language Description

The CPT® Code 75842 refers to a specialized radiological procedure known as venography, specifically targeting the adrenal veins on both sides of the body. This procedure involves the use of radiopaque contrast medium, which is a substance that enhances the visibility of internal structures during imaging. The primary purpose of this venography is to evaluate the adrenal veins, which can be crucial in diagnosing various medical conditions such as blood clots, tumors, and hormonal imbalances. In particular, the procedure is often utilized to assess levels of aldosterone, a hormone that plays a significant role in regulating blood pressure and electrolyte balance. The process typically begins with the access of the femoral vein, usually through a large bore needle inserted in the groin area. A guidewire is then carefully threaded through the needle and advanced into the vena cava, allowing for precise positioning to visualize the adrenal veins. Following this, a catheter is inserted over the guidewire to reach the desired location, and the guidewire is subsequently removed. Blood samples may be collected during this procedure for further testing of aldosterone levels, especially if there are indications of abnormal hormone levels. After the contrast medium is injected through the catheter, x-ray images of the adrenal veins are captured to provide detailed insights into their condition. The procedure concludes with the removal of the catheter, and the entire process is accompanied by radiological supervision, which includes the review and interpretation of the images obtained, culminating in a comprehensive written report of the findings.

1. Indications

The venography procedure described by CPT® Code 75842 is indicated for several specific medical conditions and diagnostic purposes. These include:

Diagnosis of Blood Clots - The procedure is performed to identify the presence of thrombus formation within the adrenal veins, which can lead to significant complications if left untreated.
Detection of Tumors - Venography can help in visualizing any abnormal growths or tumors in the adrenal region, aiding in the diagnosis and management of adrenal tumors.
Assessment of Hormonal Levels - The procedure is utilized to obtain blood samples for testing aldosterone levels, particularly when there are suspicions of hormonal imbalances that may affect blood pressure and fluid balance.

2. Procedure

The venography procedure involves several critical steps to ensure accurate imaging and assessment of the adrenal veins. The steps are as follows:

Step 1: Accessing the Femoral Vein - The procedure typically begins with the patient positioned appropriately, and the femoral vein is accessed using a large bore needle. This access point is usually located in the right or left groin area, allowing for optimal entry into the venous system.
Step 2: Insertion of the Guidewire - Once the femoral vein is accessed, a guidewire is threaded through the needle. This guidewire is carefully advanced into the vena cava, which is the large vein that carries blood to the heart, ensuring that it is positioned correctly to visualize the adrenal veins.
Step 3: Catheter Insertion - A catheter is then inserted over the guidewire to reach the selected location within the adrenal veins. This step is crucial for delivering the contrast medium needed for imaging. After the catheter is in place, the guidewire is removed, leaving the catheter in position.
Step 4: Blood Sample Collection - If there is a suspicion of abnormal hormone levels, blood samples may be obtained through the catheter for testing, particularly for aldosterone levels.
Step 5: Injection of Contrast Medium - The next step involves the injection of radiopaque contrast medium through the catheter. This contrast agent enhances the visibility of the adrenal veins during imaging.
Step 6: Imaging - X-ray images of the right and/or left adrenal veins are obtained following the injection of the contrast medium. These images are critical for evaluating the condition of the adrenal veins.
Step 7: Catheter Removal - At the conclusion of the study, the catheter is carefully removed, and the access site may be bandaged as necessary.

3. Post-Procedure

After the venography procedure is completed, patients may be monitored for any immediate complications related to the access site or the procedure itself. It is common for patients to experience some discomfort or bruising at the site where the femoral vein was accessed. Recovery time may vary, but patients are generally advised to rest and avoid strenuous activities for a short period following the procedure. Additionally, the results of the imaging and any blood tests performed will be compiled into a written report, which will be reviewed by the physician to determine the next steps in diagnosis or treatment based on the findings.

Short Descr	VEIN X-RAY ADRENAL GLANDS
Medium Descr	VENOGRAPHY ADRENAL BILATERAL SELECTIVE RS&I
Long Descr	Venography, adrenal, bilateral, selective, radiological supervision and interpretation
Status Code	Active Code
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	1 - Diagnostic Tests for Radiology Services
Multiple Procedures (51)	6 - Special payment adjustment rules on the technical component (TC) of multiple diagnostic cardiovascular services apply...
Bilateral Surgery (50)	2 - 150% payment adjustment does NOT apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	T-Packaged Codes
ASC Payment Indicator	Packaged service/item; no separate payment made.
Type of Service (TOS)	4 - Diagnostic Radiology
Berenson-Eggers TOS (BETOS)	I4B - Imaging/procedure - other
MUE	1
CCS Clinical Classification	191 - Arterio- or venogram (not heart and head)

26	Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number.
XU	Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service