General Surgery Coding Alert

Question: Which code should I use for creating an AV fistula for vascular access?


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Answer: The appropriate code depends on the type of graft the surgeon uses to create the arteriovenous (AV) fistula. An autogenous graft, as described by 36825 (Creation of arteriovenous fistula by other than direct arteriovenous anastomosis [separate procedure]; autogenous graft), uses material taken from the patient's own body, while a nonautogenous graft (36830, ... nonautogenous graft) is made of a biocompatible material, such as Gortex.

Following an AV fistula creation, complications may arise. For instance, the fistula may thrombose (clot), or the patient could develop an infection and thus require a revision.

If the surgeon revises an AV fistula without thrombectomy (in other words, removal of thrombus, or blood clot), the appropriate code is 36832 (Revision, open, arteriovenous fistula; without thrombectomy, autogenous or nonautogenous dialysis graft [separate procedure]).

Report revision with thrombectomy using 36833 (... with thrombectomy ...). If the surgeon removes a thrombus only, without revising the fistula, you may report either 36831 (Thrombectomy, open, arteriovenous fistula without revision, autogenous or nonautogenous dialysis graft [separate procedure]) for an open procedure or 36870 (Thrombectomy, percutaneous, arteriovenous fistula, autogenous or nonautogenous graft [includes mechanical thrombus extraction and intra-graft thrombolysis]) for a percutaneous procedure.

If a revision or thrombectomy occurs within 90 days of the fistula's creation, it falls within the original procedure's global period. Therefore, you must append modifier 79 (Unrelated procedure or service by the same physician during the postoperative period) to 36831 or 36833, as appropriate. Technical and coding advice for You Be the Coder and Reader Questions provided by Marcella Bucknam, CPC, CCS, CPC-H, CCS-P, HIM program coordinator at Clarkson College in Omaha, Neb.