How would you code the following case? Our codes are the following:
36255-50, 36100-59-LT, 76937, 75822

We are unsure if ultrasound guidance can be coded in this case. Also, with the RUE venogram performed through IV access site, there’s no catheter placement code for this, right? Additionally, the reason we are choosing 36100 is for the LUE vein branch that was punctured for the LUE venogram. We are also unsure if the LT modifier is used on 36100.

Pre-operative diagnosis:
1. End stage renal disease on dialysis with multiple failed accesses

Post-operative diagnosis:
1. same

Procedure:
1. BL UE venogram with US guidance
2. BL UE angiogram with selective catheterization of subclavian arteries
3. Arch aortogram
4. R transfemoral artery access

Complications: none

Specimens: none

Procedure in detail:
In the angio suite the BL upper extremities were prepped and draped in the usual sterile fashion. BL groins were prepared and drapped in the usual sterile fashion. Direct US guidance was used to obtain access to the R common femoral artery with micropuncture needle, wire, and sheath. Wire and catheter were used to shoot an arch aortogram. Great vessels patent. Both R and L subclavian arteries were selectively catheterized. Angiography revealed patent vessels with sluggish flow in BL UE’s, likely cardiogenic in nature. RUE IV was used to perform venogram, which showed diffuse sclerosis of the cephalic, basilic, and brachial veins with poor caliber. Axillary veno open but somewhat small. LUE vein branch punctured with micropuncture needle, wire, and sheeth with US guidance. Venogram shows old occluded graft, patency of axillary vein. 5 Fr sheath pulled from groin. Pressure held. No hematoma.