# Angioplasty-Do we need to



## prabha

Do we need to code CPT 35475(radial artery angioplasty) & 75962 for the below procedure in addition to 35476 & 75978-26 or does inflow radial artery angioplasty is included in 35476 itself????Kindly confirm...

History: 63 year old male with end-stage renal disease on
       hemodialysis presents with poor flows from his left radio cephalic
       native dialysis fistula following hemodialysis. 


       Procedure in brief: AV shunt study, brachial artery angiogram,
       percutaneous angioplasty of inflow radial artery stenosis,
       percutaneous angioplasty of arteriovenous anastomotic stenosis,
       percutaneous angioplasty of outflow antebrachial vein stenosis,
       ultrasound guidance

       Procedure and Findings:       

       After administering local anesthesia to the overlying soft tissue,
       crossing 7 French vascular sheaths were placed into the fistula
       outflow vein in the forearm under real-time ultrasound guidance.
       Contrast injection with digital imaging of the left arm and chest
       in the frontal projection was performed. A 4 French Berenstein
       catheter and a hydrophilic guide wire were advanced through the
       sheath, guided beyond the arteriovenous anastomosis and positioned
       within the inflow brachial artery. A brachial artery angiogram was
       performed.

       These images demonstrate patency of a small caliber inflow radial
       artery.  Severe, irregular narrowing is identified extending from
       the arteriovenous anastomosis through the juxta anastomotic
       outflow venous segment for approximately 4 cm in length. In
       addition, moderate narrowing of the outflow vein extends for an
       additional 6 cm in length. Moderate narrowing is identified within
       the outflow antebrachial vein just below the elbow.  The outflow
       basilic vein in the upper arm is widely patent.The central outflow
       veins are patent.

       After crossing the venous outflow with a floppy guidewire, the
       antebrachial venous stenosis was dilated using an 8 mm x 8 cm
       angioplasty balloon. The juxta anastomotic stenosis was
       sequentially dilated using 6-mm and  8mm by 4-cm Cordis
       angioplasty balloons.  The inflow radial artery extending for
       approximately 6 cm in length was sequentially dilated using a 5 mm
       x 4 cm and 6 mm x 4 cm Cordis Extreme angioplasty balloons. An
       improved thrill was palpated within the fistula outflow vein at
       this time. A final angiogram was performed demonstrating
       demonstrating brisk flow through the fistula with minimal residual
       irregularity at the angioplasty sites. The sheaths were removed
       and hemostasis was obtained with manual compression.

       Impression:       
       Angiographic evaluation of left radiocephalic native dialysis
       fistula demonstrating inflow radial artery arteriovenous
       anastomotic, juxta anastomotic and outflow venous stenoses as
       described above. The central outflow veins are widely patent.

       Successful percutaneous angioplasty of the above mentioned lesions
       using 5 mm, 6 mm and 8 mm diameter high pressure angioplasty
       balloons as described above.


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## kimcpccircc

They have just changed, again, the codes for arterial and venous angioplasty of a fistula. You are to charge the arterial fistula 35475 and 75962-26 and 36147-51. The angioplasties appear to be within the peripheral zone. (Code arterial only as of June I think before it was venous)


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## Hari Prasadh

Can code 35475/75962 for angioplasty of the upper extremity AV fistula/graft arterial anastomosis and for a native brachial, radial, ulnar, subclavian, or brachiocephalic artery stenosis significantly away from the arterial anastomosis. Code 35475 may be used twice if separate and distinct lesions of the native artery and the arterial anastomosis are treated at the same setting.

I think you are correct. no documentation for stenosis of arterial anastamosis, would code both.

Harish, CPC, CCS


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