General Surgery Coding Alert

Improve Your Reporting of Vascular Access Procedures for Hemodialysis Vascular access procedures fall into several distinct categories, each of which involves its own CPT Codes . By understanding the differences between the types of vascular access, you can claim the procedures and their accompanying services with improved accuracy for better reimbursement results. As Easy As One, Two, Three There are three common types of vascular access for hemodialysis: arteriovenous (AV) fistulae (including anastomosis), cannulae, and catheters, says Jan Rasmussen, CPC, president of Professional Coding Solutions, an Eau Claire, Wis.-based firm providing coding support, compliance review and contract coding to physicians nationwide. An AV fistula is an internal, surgically created connection between a patient's artery and vein, usually in the forearm. Connecting the artery to the vein allows more blood to flow into the vein, not only enlarging it but strengthening it and making repeated needle insertions easier. "This technique has the lowest rates of complications for hemodialysis, but you can't use it immediately. It takes several weeks or months to mature, heal and develop in size," Rasmussen says. Report creation of an AV fistula using 36825 (Creation of arteriovenous fistula by other than direct arteriovenous anastomosis [separate procedure]; autogenous graft) or 36830 ( nonautogenous graft), depending on the type of graft. An autogenous graft, as described by 36825, uses material taken from the patient's own body, while a nonautogenous graft (36830) is made of a biocompatible material, e.g., Gortex. Note: Because an AV fistula cannot function until it has healed and matured, the physician must often provide hemodialysis by another method (e.g., catheter) or nonhemodialysis such as peritoneal dialysis for some time after creation of the fistula. Report such services separately using the appropriate CPT procedure codes (see below). Following creation of an AV fistula, complications may arise. For instance, the fistula may thrombose (clog), or the patient could develop an infection and thus require a revision, says Kathleen Mueller, RN, CPC, CCS-P, a general surgery coding and reimbursement specialist in Lenzburg, Ill. If the surgeon revises an AV fistula without thrombectomy (i.e., removal of thrombus, or blood clot), the appropriate code is 36832 (Revision, open, arteriovenous fistula; without thrombectomy, autogenous or nonauto-genous dialysis graft [separate procedure]). Report revision with thrombectomy using 36833 (... with thrombectomy ...). If the surgeon removes a thrombus only, without revision of 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. Note: CPT added 36870 in 2001 to replace use of unlisted-procedure codes to report this procedure. If a [...]