# 2 stage AVF with basilic vein transposition



## madcomic2000 (Jan 28, 2014)

We have a new doctor who joined our group.  He states he does this procedure in 2 stages.  Creates the AVF first, then does the basilic vein transposition in the 2nd surgery.  I don't have any op notes to provide as I am just researching if anyone else bills for this.  Any help would be appreciated on the CPT codes.  
Melissa


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## kmeagher (Jan 3, 2019)

Per AHA Coding Clinic for HCPCS Q2 2013:

QUESTION 3
When performing two-staged vein
transposition with either the upper
arm basilic or cephalic vein for an
AV fistula, what is the correct CPT
code to report for each individual
part of the staged procedure?
In the first stage of the procedure,
the surgeon performs the
vein transposition by creating an
anastomosis between the cephalic
vein and radial artery. During the
second stage of the procedure,
"superficialization" was performed,
a procedure where the fistula
is brought up closer to the
skin.
ANSWER
Based on the documentation sub-
mitted in the operative report for
Stage 1 of the procedure, report
CPT code 36821, Arteriovenous
anastomosis, open; direct, any site
(e.g., Cimino type), and CPT code
36832, Revision, open, arteriovenous
fistula; without thrombectomy)~
autogenous or nonautogenous
dialysis graft (separate
procedure), for the Stage 2 portion
of the procedure.
When the procedure is performed
in a single operative session
ns opposed to two stages, only
CPT code 36818, Arteriovenous
anastomosis, open; by 11pper arm
cephalic vein transposition,
or CPT code 36819,
Arteriovenous anastomosis,
open; by upper arm basilica
vein transposition, would
be reported.
Additionally,.modifier.. ~-
58, Staged or related procedure
or service by the same
physician during the
postoperative period, would
be appended to CPT code
36832 for the second stage
of the procedure. Please
note char for facility reporting, the
postoperative period would be the
same day.


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