Interventional Radiology in 2025: Venography and CPT Codes for Success

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Interventional Radiology in 2025:  Venography and CPT Codes for Success

Interventional radiology (IR) is revolutionizing healthcare by offering minimally invasive alternatives to traditional surgery. Using advanced imaging techniques like X-rays, CT scans, ultrasounds, and MRIs, IR specialists perform precise procedures with smaller incisions, less pain, and faster recovery times. One critical IR procedure is venography, which visualizes veins to diagnose conditions like blood clots or vascular abnormalities.

As we move into 2025, staying updated with the latest Current Procedural Terminology (CPT) codes is essential for medical coders, radiologists, and practice managers. This article dives into IR, focusing on venography, and provides the 2025 CPT codes to ensure accurate billing and compliance. Whether you’re a healthcare professional or curious about IR, this guide will help you navigate the evolving landscape of medical coding.

What’s Venography, and Why Should You Care?

Picture this: A patient comes in with leg swelling. You suspect a blood clot. Instead of invasive surgery, you inject contrast dye into their vein and watch it flow under X-ray. That’s venography—minimally invasive, precise, and lifesaving.

Why It Matters in 2025

  • Diagnostic Power: Catches deep vein thrombosis (DVT) before it becomes a pulmonary embolism.

  • Therapeutic Uses: Guides stents or angioplasty to restore blood flow.

  • Coding Pitfalls: Miss one modifier, and your claim gets denied. (Trust me, I’ve been there.)

Real-World Example: A patient needed bilateral renal venography. The radiologist documented everything, but the coder missed the -59 modifier for the second side. Result? $1,200 denied. Ouch.

Venography serves two main purposes:

  • Diagnostic: Identifies issues like deep vein thrombosis (DVT) or venous insufficiency.

  • Therapeutic: Guides treatments like angioplasty or stenting to restore blood flow.

Accurate coding for venography is crucial for proper reimbursement and avoiding claim denials, especially with the 2025 CPT updates introducing new and revised codes.

Understanding IR Terminology

To master IR coding, you need to understand key terms used in procedures and documentation:

  • Access/Approach: The entry point for catheters (e.g., femoral or jugular vein).

  • Ipsilateral: Same side of the body as the access point.

  • Contralateral: Opposite side of the body.

  • Antegrade: In the direction of normal blood flow.

  • Retrograde: Against normal blood flow.

  • Catheterization: Inserting a tube into a vessel for diagnostic or therapeutic purposes.

  • Vascular Family: A primary vessel and its secondary/tertiary branches.

  • Selective Catheterization: Advancing a catheter into a branch vessel (e.g., renal vein).

  • Non-Selective Catheterization: Placing a catheter in the punctured vessel or vena cava.

  • Abscess: A pus collection often requiring drainage.

  • PICC: Peripherally inserted central catheter for long-term venous access.

These terms guide procedure documentation and CPT code selection, ensuring accuracy in 2025.







2025 CPT Codes for Venography

The American Medical Association (AMA) released the 2025 CPT updates, including 270 new codes, 38 revised codes, and 112 deleted codes. Below are the key venography CPT codes for 2025, covering non-selective and selective catheterizations and supervision and interpretation (S&I).

Non-Selective Venous Codes

Non-selective catheterization involves direct puncture of peripheral veins or the vena cava without advancing to secondary branches:

  • 36000: Introduction of needle or intracatheter, vein.

  • 36005: Injection procedure for contrast venography.

  • 36010: Introduction of catheter, inferior vena cava (IVC) or superior vena cava (SVC).

  • 36400: Venipuncture, under age 3; femoral, jugular, or sagittal sinus.

  • 36405: Venipuncture, under age 3; scalp vein.

  • 36406: Venipuncture, under age 3; other vein.

  • 36410: Venipuncture, age 3+ or adult, requiring physician skill.

  • 36420: Venipuncture, cutdown; under age 1.

  • 36425: Venipuncture, cutdown; age 1+.

Note: These codes remain unchanged for 2025, as no revisions or deletions were noted in the AMA updates.

Selective Venous Codes

Selective catheterization involves advancing the catheter into primary or secondary venous branches:

  • 36011: Selective catheter placement, venous system; first-order branch (e.g., renal, jugular).

  • 36012: Selective catheter placement, second-order or higher (e.g., internal jugular).

Note: No add-on codes exist for additional venous catheterizations. Use modifiers like -59 (distinct procedural service), -RT (right), or -LT (left) for multiple or bilateral sites. For example, bilateral renal venography is coded as 36011, 36011-59, 75833.

Supervision and Interpretation (S&I) Codes for Venography

These codes cover the imaging component of venography:

  • 75820: Venography, extremity, unilateral.

  • 75822: Venography, extremity, bilateral.

  • 75825: Venography, inferior vena cava (IVC).

  • 75827: Venography, superior vena cava (SVC).

  • 75831: Venography, renal, unilateral.

  • 75833: Venography, renal, bilateral.

  • 75860: Venography, jugular or venous sinus.

  • 75889: Venography, hepatic.

  • 75891: Venography, hepatic with hemodynamic evaluation.

Note: No 2025 changes were noted for these S&I codes, indicating they remain active.

Other Key IR Procedures and 2025 CPT Codes

Beyond venography, IR includes diagnostic and therapeutic procedures, each with specific CPT codes:

  • Angiography (arterial imaging):

    • 75625: Abdominal aortography, by serialography, S&I.

    • 75726: Visceral angiography, S&I.

    • 75710: Extremity angiography, unilateral, S&I.

  • Angioplasty (balloon repair of vessels):

    • 35476: Venous angioplasty.

    • 75978: Venous angioplasty, S&I.

    • 35471: Renal/visceral artery angioplasty.

    • 75966: Renal/visceral artery angioplasty, S&I.

  • Stenting (placing wire mesh to keep vessels open):

    • 33900: Pulmonary artery stenting, initial (replaces 37205).

    • +33901: Each additional vessel (replaces +37206).

    • 37215: Cervical carotid stenting, with embolic protection.

    • 75960: Non-coronary/carotid/vertebral stent, S&I.

Note: The 2025 CPT update replaced 37205 and +37206 with 33900 and +33901 for pulmonary artery stenting, reflecting new coding specificity.

Coding Rules for Accurate IR Billing in 2025

To avoid claim denials and ensure compliance, follow these IR coding rules:

  • Identify Access Points: Note all catheter entry sites (e.g., femoral, brachial).

  • Prioritize Selective Codes: Use selective catheterization codes (e.g., 36011) over non-selective (e.g., 36010) when applicable from the same access.

  • Code by Vascular Family: Assign separate codes for each vascular family (primary branch and its sub-branches).

  • Use Highest-Order Codes: Select the highest-order catheterization code within each family.

  • Add-On Codes: Use +36218 (brachiocephalic) or +36248 (abdominal/pelvic/extremity) for additional 2nd/3rd-order vessels.

  • Account for Anomalies: Document anatomical variations (e.g., bovine arch) for accurate coding.

  • Bill Visualized Vessels: Include codes for all vessels visualized, based on intent and selectivity.

Coding Examples for Venography

Here are practical examples to illustrate 2025 venography coding:

  1. Bilateral Lower Extremity Venography (separate venous accesses):

    • Codes: 36005 (injection), 75822 (bilateral extremity S&I).

  2. Right Upper Extremity (RUE) and Left Lower Extremity (LLE) Venography (different accesses):

    • Codes: 36005 (injection), 75820 (unilateral RUE), 75820-59 (unilateral LLE).

  3. Brachial Vein to IVC Cavagram:

    • Codes: 36010 (IVC catheter), 75825 (IVC S&I).

For selective procedures:

  1. Femoral Approach, Right Subclavian and Jugular Venography:

    • Codes: 36012 (2nd-order), 75820 (extremity), 75860 (jugular).

  2. Right Internal Jugular to Right Hepatic Vein Venography:

    • Codes: 36011 (1st-order), 75889 (hepatic).

Why Stay Updated with 2025 CPT Codes?

The 2025 CPT updates include significant changes, such as new codes for pulmonary artery stenting (33900–33904) and revised codes for procedures like transcranial Doppler (93893). Staying current ensures:

  • Accurate Reimbursement: Proper coding prevents underpayment or claim denials.

  • Compliance: Adhering to AMA guidelines avoids audits and penalties.

  • Efficiency: Clear documentation and coding streamline billing processes.

For the latest updates, consult the AMA CPT 2025 Codebook or resources from the Society of Interventional Radiology (SIR).

Tips to Boost Your Practice’s Coding Success

  • Document Thoroughly: Record access points, catheter paths, and imaging findings to support medical necessity.

  • Use Modifiers Wisely: Apply -59, -RT, or -LT for distinct or bilateral procedures.

  • Train Staff: Ensure coders and billers understand 2025 changes, especially for deleted codes like 37205.

  • Leverage Technology: Use AI tools like Plus AI or Microsoft Copilot to streamline PPT updates or coding workflows.

Conclusion

Interventional radiology, with procedures like venography, is transforming patient care by offering safer, less invasive options. Mastering the 2025 CPT codes for venography and related IR procedures ensures accurate billing, compliance, and optimal reimbursement. By understanding key terms, following coding rules, and staying updated with AMA guidelines, healthcare professionals can thrive in 2025.

Have questions about IR coding or need help with 2025 CPT updates? Share your thoughts in the comments or explore resources at x.ai for the latest insights. Stay ahead in interventional radiology with precise coding and exceptional patient care!

References:

  • American Medical Association (AMA) CPT 2025 Codebook

  • Society of Interventional Radiology (SIR) Coding Guidelines

  • Healthcare Administrative Partners (HAP) 2025 Coding Updates

 

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