# AV fistula



## prabha (Aug 10, 2009)

Do we need code for unilateral extremity arteriography(75710) and catheter code(36140) along with the fistulogram codes in the below procedure?

After obtaining informed consent, the patient's right arm was prepped and
draped in a sterile fashion.  Using ultrasound guidance, a right brachia
artery was punctured and a 3 French catheter was placed in the brachial
artery. Angiogram of the brachial artery was performed. The angiogram
revealed the patient's distal brachial artery with proximal radial and
ulnar arteries to be patent.
There is an AV fistula arising from the distal brachial artery. There is
severe anastomotic stenosis and another area of stenosis in the proximal
outflow vein.
The patient's AV fistula was punctured in a retrograde fashion and a 6
French sheath was placed over the wire.  An 018 wire was needed to cross
the area of stenosis.  Over the wire, a 5 mm balloon was used to perform
angioplasty of the anastomosis and the proximal lateral vein.
Post-angioplasty with a 5 mm balloon, a 6 mm balloon was used to
performed angioplasty of the anastomosis and proximal outflow vein.
After the 6 mm angioplasty, there is marked improvement noted in the
anastomosis, however, the proximal outflow vein is still stenotic.
This was the angioplastied with an 8 mm balloon. Post-procedure,
excellent flow is seen through the AV fistula.
IMPRESSION:
Severe stenosis of the AV fistula and anastomosis and proximal outflow
vein. This is successful treatment with angioplasty. The anastomosis was
treated with a 6 mm balloon and the outflow vein was treated with an
8 mm balloon.


----------



## mikereyland (Aug 10, 2009)

I would code: 36140, 75710-26-59, 36145-59, 75790-26, 35476, 35476-59, 75978-26 x2.


----------



## Jim Pawloski (Aug 10, 2009)

mikereyland said:


> I would code: 36140, 75710-26-59, 36145-59, 75790-26, 35476, 35476-59, 75978-26 x2.



I will agree to your 36140 and 75710 codes, but the angioplasty is within a A-V shunt region.  You can only use the G0393/ 75978 in the graft and veins up to the subclavian vein per Medicare.  The placement code 36145 can be used, but I'm not sure about 75790, since there in a vague description of the venous structures.


----------



## Partha (Aug 11, 2009)

75790 is correct because report says...AV fistula arising from the distal brachial artery. There is severe anastomotic stenosis and another area of stenosis in the proximal outflow vein...

G0393/75798 upto axillary vein per Medlearn's Interventional Radiology, so we code the subclavian separately


----------



## Jim Pawloski (Aug 11, 2009)

Partha said:


> 75790 is correct because report says...AV fistula arising from the distal brachial artery. There is severe anastomotic stenosis and another area of stenosis in the proximal outflow vein...
> 
> G0393/75798 upto axillary vein per Medlearn's Interventional Radiology, so we code the subclavian separately



I asked the radiologists that I work with, and their opinion is when they say "proximal outflow vein", they are describing the area from venous anastmosis to the subclavian vein, going by direction of blood flow. Check with the doctor if that is what he means.


----------

