# Dialysis Circuit Procedures



## staceylh (Jul 19, 2019)

A question from one of our anesthesia coders related to angioplasty on dialysis circuit: how can they determine which way to code anesthesia?  If coding CPT 39603 with US/fluoro guidance would it be correct to use 01930 for the anesthesia?  Or would it only be appropriate to use that code if the procedure was performed by IR provider?


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## LisaAlonso23 (Jul 25, 2019)

Look at 36902. It's specifically for angioplasty on the peripheral dialysis segment (av fistula is on the arm) and crosswalks to 01916 (5 units). 

Not having the op report, I only see 36902 being appropriate, as a stent is not mentioned.


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## ernist8489 (Jul 27, 2019)

@staceylh b Are you SURE Your not referring to Moderate Conscious sedation? Which is renderred by the IR provider usually with Versed, Ketamine, Toradol, Morphine etc? If ypou look at the IR Report and it says "Moderate Conscious Sedation was administered by () for a total of X amount of minutes. If it says MCS was uses you would never use the ASA/CPT code's (0000 series) you code moderate conscious sedation by counting every 15 minutes as 1 Unit like normal anesthesia time units . 99152-1st 15 minutes. (+)99153-each additional 15 minutes (75 minutes) 99152-1st 15 minutes. 99153 X 4. So Lisa is absolutely correct in this instance, as 36902 is for peripheral dialysis circuit fistulagram and Transluminal Angioplasty. 36903 is for peripheral dialysis circuit fistulagram & Transluminal Stent Placement which includes all angioplasty within the peripheral dialysis circuit. Now, the question I have relates to your final portion of your question that's an interesting one because 01916 is for diagnostic Venography/Arteriography which would probably work however An angioplasty was performed so the diagnostic portion of the intervention is part of the therapy which was the angioplasty, so if it were me coding the actual anesthesia portion IF THE ANESTHESIA that was rendered was general or Monitored Anesthesia Care performed by an anesthesiologist or a CRNA then I would go 01930 because it is for Anesthesia for venous or lymphatic interventions NOS. Since there is no specific code for Anesthesia for Therapeutic interventions of Dialysis Circuit I would go that route. Because it wasn't just diagnostic angiography that was done, the angioplasty was done as well which it makes the Dx angio 01916 inherent to what is done in the 01930.


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## AnneMcoder50 (Dec 13, 2019)

I'm struggling with when to use an Interventional Radiology code (such as 01930) or a code that seems more specific such as 01850.  What determines using an Interventional Radiology code? If a CPT code crosswalks to both codes, are they both correct, and is one more appropriate than the other?  Does it matter if the procedure is done in an OR versus the Radiology Dept?  Is one code for "open" procedures and the other less invasive?  I have researched and cannot find an definitive answer as to what code to use.


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