Summary & Overview
CPT 38200: Splenoportography of the Portal Venous System
CPT code 38200 represents splenoportography, a diagnostic radiologic procedure in which a catheter is placed in the splenic vein and contrast is injected to visualize the portal venous system. Nationally, this code is used for evaluation of portal vein patency, assessment of portal hypertension, and characterization of portal-system vascular anatomy prior to or as part of interventional therapy. The procedure is typically performed in hospital radiology or interventional radiology settings using fluoroscopic guidance.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for the procedure, common billing considerations, and the typical sites of service. The publication summarizes benchmarks where available, highlights relevant policy and coverage considerations at a national level, and explains how the code fits into diagnostic and interventional care pathways. Data not available in the input are noted where applicable, including specific payer reimbursement rates, associated taxonomies, and ICD‑10 diagnosis pairings.
Billing Code Overview
CPT code 38200 describes a splenoportography procedure in which a provider inserts a catheter into the splenic vein, injects contrast material, and acquires X‑ray images to evaluate the portal venous system. This imaging study is performed to assess portal vein patency, portal hypertension, and related vascular anatomy.
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Service type: Diagnostic vascular radiologic procedure involving direct venous catheterization and contrast injection
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Typical site of service: Hospital radiology suite or interventional radiology laboratory, often performed with fluoroscopic guidance
Clinical & Coding Specifications
Clinical Context
A typical patient is a 55-year-old with known cirrhosis and progressive ascites with new-onset portal hypertension signs (refractory variceal bleeding or suspected portal vein thrombosis). The hepatology team requests diagnostic splenoportography to visualize portal venous anatomy and assess portal vein patency and pressure gradients prior to planning portosystemic shunt, transjugular intrahepatic portosystemic shunt (TIPS), or surgical intervention. The patient arrives to the interventional radiology suite fasting, with IV access and coagulation studies reviewed. Conscious sedation or monitored anesthesia care is provided. Under ultrasound guidance, the interventional radiologist accesses the splenic vein via a percutaneous transsplenic or transhepatic approach, advances a catheter into the splenic vein, injects iodinated contrast, and acquires fluoroscopic images to evaluate portal venous flow, variceal supply, and thrombosis. Post-procedure monitoring includes analgesia, hemostasis observation, and instructions about activity and signs of bleeding or infection. Documentation includes indication, informed consent, access site, catheter type, contrast volume, fluoroscopy time, findings, and any complications.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing physician interpretation separate from facility technical component. |