Cardiology Coding Alert

Question: The physician is reporting repair of left arm dialysis AV graft with percutaneous transluminal deployment of two covered stent grafts for two focal pseudoaneurysms with operative fistulogram. Which codes should I use for a Medicare patient?Codify MemberAnswer: You should report stent placement using 37205 (Transcatheter placement of an intravascular stent[s] [except coronary, carotid, vertebral, iliac, and lower extremity arteries], percutaneous; initial vessel). Both stents are in a single vessel, the arteriovenous (AV) graft, so you should report only one unit of 37205, which applies to all stents in the "initial vessel."Code 36147 (Introduction of needle and/or catheter, arteriovenous shunt created for dialysis [graft/fistula]; initial access with complete radiological evaluation of dialysis access, including fluoroscopy, image documentation and report [includes access of shunt, injection(s) of contrast, and all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava]) describes fistulogram [...]