Q: How do I report a thoracic duct cannulation with subsequent catheterization and embolization when a chyle leak is seen at the time of a lymphangiogram?
A: Thoracic duct cannulation is reported using CPT code 38794 (cannulation, thoracic duct) in addition to 38790 for the lymphangiography injection. As the lymphatic system is considered an extension of the venous system, selective catheterization can be reported using existing first and second order catheter selection codes (e.g., 36011, 36012). Embolization (e.g., glue, coils, plug) of the thoracic duct for lymphatic extravasation is reported using 37244. To note, this embolization code is inclusive of all radiological supervision and interpretation, intraprocedural road mapping and imaging guidance to complete the intervention.
- 38790 – Injection procedure; lymphangiography
- 38794 – Cannulation, thoracic duct
- 36011 – Selective catheter placement, venous system; first order branch (e.g., renal vein, jugular vein)
- 36012 – Selective catheter placement, venous system; second order, or more selective, branch (e.g., left
- adrenal vein, petrosal sinus)
- 37244 – Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation
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