Anesthesia Coding Alert

Question: What is the correct anesthesia code to report AV (arteriovenous) fistula through the groin?

New York Subscriber

Answer: The best surgical codes for this procedure are 36800 (Insertion of cannula for hemodialysis, other purpose [separate procedure]; vein to vein) and 36821 (Arteriovenous anastomosis, open; direct, any site [e.g., Cimino type] [separate procedure]). Both of these codes cross to anesthesia code 01844 (Anesthesia for vascular shunt, or shunt revision, any type [e.g., dialysis]), but many coders have problems using 01844 for these types of procedures since it is in the "Forearm, wrist and hand" section of codes.

Remember that the groin is defined as the thigh-to-trunk region. Because of this, a better code for an AV fistula in the groin would be either 01260 (Anesthesia for all procedures involving veins of upper leg, including exploration) or 01270 (Anesthesia for procedures involving arteries of upper leg, including bypass graft; not otherwise specified).

Since the AV fistula procedure is both arterial and venous, and code 01270 has a higher base unit value, it's often the first choice for anesthesia coding. If the fistula is venous-venous (which is not as common as arterial-venous), code 01260 would be more appropriate because of the lack of any surgery on arteries.

You Be the Coder and Reader Questions and were reviewed by Jan Dyer-Perry, owner of Jan's Medical Billing Service in Warren, Maine.