Thank you, Dr. Ng. I appreciate that. And just to quickly reiterate, I think, you know, as presenters of this particular webinar, you know, we may be considered experts, although I might put that in quotation marks in the sense that we have spent a lot of time and energy discussing these things amongst ourselves, trying to make sure that there's some uniformity and agreement. But in fact, you know, we know that there's some gray zones to that. And so we're, we're presenting tonight, all of us are presenting what we think are best practices for CPT coding. And I'm going to lead us off here with the new venography codes that were almost half the way through the year. But these were the new 2024 CPT codebook codes for the venography code set. And the first code was the 93584 that was added. This was for an additional SVC, so or a contralateral SVC, which so for the first or only SVC that somebody has, which may be the case for Citus Inversus, for instance, one would code the SVC code that is already existent, 75827. If there's any time a second SVC that's then also injected, then we code this new code 93584. Here are some examples that I'm showing you of a right-sided SVC on the left side of the panel, going to right atrium, that would be a normal one. And then on the other side, in this same particular patient, you can see there's a small bridging anominate vein at the top there, which is really not terribly important, as this is really the big carrier flow from the left side of the upper neck and arm. So a left SVC, in this case, draining to the coronary sinus. Here's just another example of someone who actually has a larger anominate vein, but also has a left-sided SVC and a right-sided SVC. In this case, the right SVC was injected. And unless this left one were done, that would be separate. Here's just another example of getting to it from a different location. We're going up an azygous vein, in this case, going down into the chambers of a patient with heterotaxy syndrome and up into the right SVC. But again, if that's the only one injected, we would code that as a 75827. If it was the second one, we would use this code, the new code. The second code is the 93585 for azygous and hemiazygous. You kind of get a chance to see what these things look like. There's a variety of different things, how these can look, whether they're left-sided or right-sided, sometimes, in this case, crossing over. The injection here was in an azygous. Whether you term that an azygous or a hemiazygous, it would be the same code. Here's a lateral showing that it's behind the heart as it enters into the superior vena cava from above. It's not going through the hepatic vein. And here's just another example of a hemiazygous. The third code is the 93586, the coronary sinus code. And here's somebody with a lateral cable tunnel fontan. The injection was actually in that lateral cable tunnel. We started to see something that looked a little funny here. And then we went directly into the coronary sinus and injected that. And you can see that there was also some collateralization, but that's not as important as what we did here with the direct injection selectively into the coronary sinus. Again, these are all selective codes. And then the final two codes are for veno-venous collaterals. And again, this is not including transcatheter closure of any kind, but if one only does a selective injection. On the left-sided panel, you can see a picture that was done in the innominate vein that drains into its respective pulmonary arteries. But then there happens to be a VV collateral, veno-venous collateral vessel that is not selectively injected, but showed up on the picture. Then the catheter was put in selectively for that picture. And the code of 93587 is warranted. Keep in mind that there's an MUE of 2. What that means is that you can use that code twice, but not more than twice. So if you had seven collaterals that you did selectively, you only get to use it twice. That is the current. And MUE is kind of funny terminology that means medically unlikely edits. It's part of the CPT RUC nomenclature. And then finally, this is, and what I failed to say, I guess, is that these are veno-venous collaterals that happen to arise from above the heart, as opposed to 93588, where the veno-venous collaterals arise from below the heart. And here you have, and maybe this is not, maybe that is in the way here, not sure. But here you see a collateral where the catheter is actually almost below the diaphragm or at that level and injecting directly into a vessel that then courses superiorly. You can see this is a veno-venous collateral vessel and happens then drain down into a left-sided SVC. The important thing is that this was selectively in this VV collateral. So those are those, and I just wanted to kind of thank you all for your attention, and I will close it out.

CPT coding

venography codes

2024 CPT codes

selective injections

MUE limitations