CPT® Code 75872

Official Description

Venography, epidural, radiological supervision and interpretation

Common Language Description

The CPT® Code 75872 refers to the procedure known as venography of the epidural space, which involves radiological supervision and interpretation. This procedure utilizes a radiopaque contrast medium, which is a substance that enhances the visibility of internal structures during imaging studies. The primary purpose of this venography is to evaluate the epidural venous vasculature, which is crucial for diagnosing conditions such as epidural tumors or herniation of intervertebral discs that may encroach upon the epidural space. The epidural space itself is anatomically defined as the compartment located between the dural sheath and the spinal canal, extending from the cervical vertebrae down to the sacrum. Within this space, there exists a complex venous plexus, along with semi-liquid fat, lymphatics, arteries, connective tissue, and spinal nerve roots. The epidural venous system is composed of two main components: the internal vertebral venous plexus, which consists of four interconnecting longitudinal vessels (two anterior and two posterior), and the external vertebral plexus, which is situated peripheral to the vertebrae. The venous drainage from the vertebral veins in the cervical region connects to the subclavian vein, while the azygous and hemizygous veins in the thoracic area drain into the superior vena cava. In the abdominal region, the ascending lumbar veins and the internal iliac veins in the pelvic area converge into the common iliac veins and ultimately into the inferior vena cava. During the procedure, access is gained to the right or left femoral vein using a large bore needle, through which a guidewire is introduced into the vena cava. A catheter is then advanced over the guidewire to the designated area for the injection of the contrast medium. Following the injection, x-ray films are taken to visualize the epidural veins. The CPT® Code 75872 encompasses not only the radiological supervision of the venography procedure but also the review and interpretation of the obtained images, culminating in a comprehensive written report detailing the findings of the study.

1. Indications

The venography procedure indicated by CPT® Code 75872 is performed for specific clinical conditions that necessitate detailed evaluation of the epidural venous system. The following indications are explicitly recognized for this procedure:

Epidural Tumors - The procedure is utilized to diagnose the presence of tumors located within the epidural space, which may require further intervention or management.
Herniated Intervertebral Discs - Venography is indicated for assessing herniation of intervertebral discs that may protrude into the epidural space, potentially causing neurological symptoms or complications.

2. Procedure

The venography procedure as described by CPT® Code 75872 involves several critical steps to ensure accurate imaging of the epidural venous system. The following procedural steps are outlined:

Accessing the Femoral Vein - The procedure begins with the insertion of a large bore needle into either the right or left femoral vein. This access point is chosen for its proximity to the vena cava, facilitating the subsequent steps of the procedure.
Threading the Guidewire - Once access to the femoral vein is established, a guidewire is carefully threaded through the needle and advanced into the vena cava. This guidewire serves as a pathway for the catheter that will be used for contrast injection.
Inserting the Catheter - A catheter is then inserted over the guidewire and advanced to the selected area within the epidural venous system where contrast medium will be injected. This step is crucial for ensuring that the contrast is delivered to the appropriate location for optimal imaging.
Injecting Contrast Medium - After the catheter is positioned correctly, a radiopaque contrast medium is injected. This substance enhances the visibility of the epidural veins during imaging.
Obtaining X-ray Films - Following the injection of the contrast medium, x-ray films are obtained to visualize the epidural veins. These images are essential for the subsequent interpretation and diagnosis.

3. Post-Procedure

After the completion of the venography procedure, several post-procedure considerations are important for patient care and follow-up. The expected recovery process typically involves monitoring the patient for any immediate complications related to the venous access or contrast injection. Patients may be advised to rest and avoid strenuous activities for a short period following the procedure. Additionally, the results of the venography, including the interpretation of the x-ray images, will be compiled into a written report, which will be essential for guiding further clinical management based on the findings.

Short Descr	VEIN X-RAY SKULL EPIDURAL
Medium Descr	VENOGRAPHY EPIDURAL RS&I
Long Descr	Venography, epidural, 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)	0 - 150% payment adjustment for bilateral procedures 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)

This is a primary code that can be used with these additional add-on codes.

37252	Addon Code MPFS Status: Active Code APC N ASC N1 Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure)
37253	Addon Code MPFS Status: Active Code APC N ASC N1 Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; each additional noncoronary vessel (List separately in addition to code for primary procedure)

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.
TC	Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component charges are institutional charges and not billed separately by physicians; however, portable x-ray suppliers only bill for technical component and should utilize modifier tc; the charge data from portable x-ray suppliers will then be used to build customary and prevailing profiles
XS	Separate structure, a service that is distinct because it was performed on a separate organ/structure