# Pls help me code this AV fistula case!



## sivaprabha (Mar 23, 2012)

Some one out there pls help me! 

 I'm confused with the update in AV fistula coding regarding the usage of 36215 for beyond the fistula access. Pls help me code this case. Should we code 36215 in this scenario???? 

Report
INDICATIONS:

74-year-old male with history of chronic renal failure on hemodialysis through a
right forearm radiocephalic fistula, this was placed in 2006 and has functioned
well but of late has become unreliable with diminished flows, and recurrent
thrombosis.  Recent angiography demonstrated arterial inflow stenosis, the
patient now returns with a thrombosed access.

PROCEDURE:

Following patient interview and examination, and informed consent, the patient
was brought to the procedural suite and placed supine with the right arm
extended on an arm board.  The right forearm was prepped and draped in the usual
fashion and the overlying skin infiltrated with buffered lidocaine.  Full
sterile barrier techniques were employed, antegrade access to the fistula was
performed and a 6-French sheath placed.  Mechanical thrombolysis of the graft
and outflow was followed by placement of a retrograde sheath and Fogarty balloon
thrombectomy of the arterial inflow.  Angiography then revealed a redundant and
narrowed arterial anastomotic and post anastomotic segment, a steerable catheter
and guidewire were manipulated across the arterial anastomosis into the proximal
radial artery and angiography demonstrated no radial artery inflow lesion.  4 mm
balloon angioplasty of the anastomotic area was performed and improved thrill
was palpable, however the suspicion that this is a relatively elastic lesion and
may recur is raised.  The arterial anastomotic region will likely require
surgical revision.  Centrally the veins are widely patent to the superior vena
cava.

Upon completion the catheter and sheath were withdrawn and the puncture sites
compressed until hemostasis was achieved.  The patient tolerated the procedure
well without incident.

Fluoro time:  13 minutes

Puncture site closures:  Manual compression

Complications:  None.

IMPRESSION:

1.  SPONTANEOUS RETHROMBOSIS OF A RIGHT FOREARM RADIOCEPHALIC DIALYSIS ACCESS
FISTULA.

2.  MECHANICAL THROMBOLYSIS OF THE FISTULA FOLLOWED BY ANGIOGRAPHY FROM THE
ARTERIAL ANASTOMOSIS TO THE CENTRAL OUTFLOW DEMONSTRATING RECURRENT NARROWING AT
THE ARTERIAL ANASTOMOTIC REGION PRESUMABLY ON THE BASIS OF A RELATIVELY ELASTIC
REDUNDANT ARTERIAL ANASTOMOSIS.

3.  4 MM BALLOON ANGIOPLASTY OF THE RADIAL ANASTOMOTIC REGION AND ANGIOGRAPHY OF
THE RADIAL ARTERY DEMONSTRATING NO EVIDENCE OF RESIDUAL INFLOW LESION (HOWEVER
ELASTIC RECOIL IN THIS AREA IS LIKELY OCCURRING AND SURGICAL REVISION WILL
LIKELY BE REQUIRED).


----------



## dibosmiley (Apr 3, 2012)

*36215*

I wouldn't since it doesn't sound as if the catheter placement was significantly beyond the anastomic region.


----------



## jewlz0879 (Apr 6, 2012)

Honestly, I've never utilized 36215/36216 for Fistula's; when the physician places the catheter into the brachial artery and then does fistulogram (which my docs sometimes do) I code 36120/75791 or 36140. Otherwise, I use 36147 for the fistulogram and 36148 if a second placement is made.

I see: 36870, 35475, and 75962-26.


----------

