This column swap could mean an additional $552 for your practice. This has been a year of changes for coding angioplasty of arteriovenous dialysis grafts. The latest Correct Coding Initiative (CCI) version, effective Oct. 1, 2010, adds to the list with a column swap that could be good news for your practice. Start With the 35475, 35476 Edit Facts The two codes involved in the edit are the following: Old way: Column 1 Column 2 35476 35475 As a result, 35475 (arterial) was bundled into 35476 (venous). New way: Effective Oct. 1, 2010, CCI swaps the edit pair for physician edits, so that 35476 (venous) is bundled into 35475 (arterial): Column 1 Column 2 35475 35476 Grasp How Column Change Affects Fee According to CCI rules, if you report both codes in a column 1/column 2 edit pair to Medicare or another payer who adopts CCI edits, the payer will reimburse you for the code in the column 1 position only (unless circumstances support overriding the edit with a modifier, in which case you will receive reimbursement for both). Medicare's national rate for 35475 is higher than for 35476, so the column swap places the higher valued code in the column 1 position: Code Non-facility price Facility price 35475 $2,221.22 $522.12 35476 $1,669.24 $331.12 Difference $551.98 $191.00 Compare CCI Edit to Coding Recommendations This new CCI edit column swap comes on the heels of other significant 2010 changes for coding percutaneous transluminal angioplasty (PTA) of arteriovenous (AV) grafts and fistulas. Change 1: The deletion of those codes meant that coders returned to using 35475 and 35476 for AV fistula or graft PTA, Midkiff notes. You should use 35475 when the physician performs angioplasty of the AV fistula arterial anastomosis, and use 35476 for venoplasty of the venous anastomosis. (Remember, anastomosis is the interconnection of the artery and vein.) The edit becomes an issue when you must code for angioplasty of both the arterial and venous sides of the fistula because payers consider the arterial to the venous side to be a single vessel, and you may report only one PTA per vessel. For example, Part B MAC NGS Medicare states the following in its local coverage determination (LCD) L30737: "For AV dialysis native fistulae, the 'vessel' is defined as the inflow artery at the AV anastomosis, the AV anastomosis, and the outflow vein to the level of the axillary vein. For AV dialysis grafts, the 'vessel' is defined as the inflow artery at the arterial anastomosis, the arterial anastomosis, the entire length of the graft, the venous anastomosis, and the venous outflow to the level of the axillary vein. All PTA done within these defined segments would be coded as a single angioplasty." Change 2: NGS Medicare reflects this change in its LCD: "If a PTA is performed at the arterial anastomosis of an AV dialysis access, it could be coded as 35475/75962 [Transluminal balloon angioplasty, peripheral artery, radiological supervision and interpretation]. In this instance, all PTA done within the AV dialysis access 'vessel' would still be coded as a single PTA but would be coded with the arterial codes (35475/75962) instead of the venous codes (35476/75978 [Transluminal balloon angioplasty, venous (e.g., subclavian stenosis), radiological supervision and interpretation]), and the venous codes would not be used for any other angioplasty performed within the AV dialysis access vessel." Caution: Watch for Limited Circumstances to Report Both The 35475/35476 edit has a modifier indicator of 1, which means you may override the edit with a modifier when appropriate. Example: But expect to provide documentation of anatomically separate lesions to prove medical necessity for reporting both codes. CCI consideration: