# New to Vascular coding



## szechman09 (Nov 21, 2012)

I am teaching myself vascular coding and it seems to be a daily struggle. Could someone help with this one? 


OPERATION: STENT GRAFT REPAILR OF INFRARENAL AORTIC ANEURYSM WITH TWO PIECES, A C3 TRUNK, 31 MM. X 14.5 MM. X 15 CM. MAIN BODY THAT WENT UP THE RIGHT. ON THE LEFT, THE CONTRALATERAL LIMB WAS A 14.5 X 10 CM. CONTRALATERAL LIMB. BILATERAL FEMORAL ARTERY CUTDOWNS.
AORTOFEMORAL ARTERIOGRAM.  BILATERAL ILIAC ARTERY ANGIOPLASTY.
OPERATIVE FINDINGS: Infrarenal aortic aneurysm.


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## jewlz0879 (Nov 21, 2012)

34802
75952-26
34812-50
36200-50

441.4

You can't bill for the kissing balloons those are bundled to the stent graft nor can you bill for the imaging during, before or after placement are bundled. Do not bill 75716, 75710, 75722, 75724, 75726, 75736, 75630, 75625. 

send me an email; jewlz0879@yahoo.com. I have some stuff I can send you with case studies and answers. ;0


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## szechman09 (Dec 5, 2012)

Would you mind helping me with this one as well? 

RIGHT ARM FISTULOGRAM, RIGHT VIA FIRST THE RIGHT BRACHIAL ARTERY ACCESS AND THEN SECOND VIA THE FISTULA ACCESS. SCORED BALLOON ANGIOPLASTY WITH A 6 X 40 BALLOON OF THE CEPHALIC VEIN FISTULA AND THEN SUBSEQUENT ANGIOPLASTY VIA 7 X 40 BALLOON AND THEN AN 8 X 20 BALLOON. COMPLETION ARTERIOGRAM SHOWED IMPROVEMENT IN THE NARROWING -


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## jewlz0879 (Dec 5, 2012)

Okay so he accesed the brachial artery to perform fistulogram and then did a separate access for the intervention, correct? That' is how I'm reading what you put. If so, 

36140
75791-26
36148
35476 - RT
75978-26

If he did a fistulogram and a second access for intervention then:
36147
36148
ect...

HTH


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## donnajrichmond (Dec 6, 2012)

jewlz0879 said:


> Okay so he accesed the brachial artery to perform fistulogram and then did a separate access for the intervention, correct? That' is how I'm reading what you put. If so,
> 
> 36140
> 75791-26
> ...



36148 is add on and can only be used with 36147 - so your first example would not be correct. Also, 75791 cannot be coded with 36148. 
I would want to see the report before I coded this, but my guess is that it is a direct anastomosis fistula, not a graft, so would be 36147, 36148.  The first angioplasty is noted to be in the cephalic vein fistula - but this does not say where the 2nd and 3rd angioplasties were performed.


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## jewlz0879 (Dec 6, 2012)

You're right, you're right. My apologies. Plus it should be 36120. I'm drawing a blank but I could have  sworn there was a way to bill for brachial access and 2nd placement for intervention.


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## jewlz0879 (Dec 16, 2012)

THIS is what I was getting at:

Direct brachial access with  - 36120/75791
Separate puncture of fistula - drop 75791 add 36147

then the intervention: 35476/75978-26


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