Gain Reimbursement for the Revision of AV Fistulas and Subsequent Thrombectomies
Published on Sat Jul 01, 2000
Nugget: Optimize payment for fistula complications by correctly identifying the type of repair, documenting the procedure completely and paying attention to global periods when choosing the right billing method.
An arteriovenous (AV) fistula a surgically created connection between an artery and vein that provides future sites for hemodialysis access typically is created in a patient with renal failure for the purpose of dialysis. Thrombectomies performed during the global period of the creation of an AV fistula are not bundled, but to obtain reimbursement, the correct diagnosis code and modifier must be used, coding experts say.
The fistula creates a large blood supply to a venous system, and huge veins form on the arm, allowing easy access for dialysis, says M. Trayser Dunaway, MD, a general surgeon in Camden, S.C. The creation of the fistula itself also can be confusing because it is accompanied by the insertion of temporary devices that are used while the fistula matures.
The fistulas may take several weeks to mature, however, so catheters are implanted to allow dialysis to begin right away. Before and after the fistula matures for dialysis use, problems may occur, Dunaway says. Sometimes the connection between the artery and the vein clots off. Then you have to remove the clot to restore the patency of the vessel at the anastomosis. Sometime later, it could even be in the recovery room, the AV fistulas thrill (blood flow) is lost, so the surgeon has to fix the problem.
When to Perform a Repair
Two main procedures may be performed in these situations: thrombectomy (removal of a clot); or revision of the fistula, which occurs if the surgeon goes back in and takes the anastomosis apart and then puts it back together.
One or both of these procedures often are performed several times in the same week, depending on the patient, says Kathleen Mueller, RN, CPC, CCS-P, a general surgery coding and reimbursement specialist in Lenzburg, Ill.
A typical scenario follows: A male, 52, with renal failure is taken to surgery for AV fistula formation for dialysis. The surgeon creates the fistula using grafted tissue from the patient and also inserts two Tesio catheters that are tunneled under the skin so dialysis can begin immediately. Two days later, the patients thrill is gone because the fistula has clotted off. The surgeon goes back in, performs a thrombectomy and reconstructs the anastomosis.
Creation of AV Fistulas
The original procedure is coded as follows:
36825 creation of arteriovenous fistula by other
than direct [...]
