General Surgery Coding Alert

Question: My surgeon does a vein transposition as a staged procedure after creating a direct anastomosis. Can I bill the transposition as a staged procedure?

New Jersey Subscriber

Answer: Yes, you can bill the vein transposition (36819, Arteriovenous anastomosis, open; by upper arm basilic vein transposition) as a staged procedure following the direct anastomosis creation (36821, ...direct, any site [e.g., Cimino type], [separate     procedure]).

That is, assuming that your surgeon did both procedures in full. Having a surgeon perform a direct anastomosis for more immediate access followed by a subsequent transposition would not be unusual.

You should use modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) with 36819.

On the other hand, if the surgeon performed the transposition because of a complication in the direct fistula, modifier 78 (Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period) would be more appropriate.