Radiology Coding Alert

Question: I would like information about the new Hcpcs Codes Level II G0159. Can you tell me if this is an additional code or does it replace an existing CPT code?

Florida Subscriber

Answer: Code G0159 (percutaneous thrombectomy and/or revision, arteriovenous fistula, autogenous or nonautogenous dialysis graft) is a temporary HCPCS code that became effective Jan. 17, 2000. (See Temporary Code Helps Clear Confusion on Percutaneous Declotting Procedures, on page 33 of the December 1999 issue of Radiology Coding Alert, for an explanation of how this new code should be reported.)

Gary Dorfman, MD, president of Healthcare Value Systems in Rhode Island and past president of the Society for Cardiovascular and Interventional Radiology, notes that the creation of this code begins the process of clarifying an issue that has long perplexed radiology coders: correct coding for percutaneous declotting procedures.

Specifically, G0159 pertains to percutaneous thrombectomy of a dialysis graft or fistula, and describes percutaneous declotting by any method including mechanical devices, lyse and wait, and short infusion.

G0159 will be used until the American Medical Association (AMA) creates a permanent current procedure terminology (CPT) code, expected no sooner than 2001, and perhaps later, Dorfman says. It is possible that more than one code ultimately may be required to describe percutaneous thrombectomy services because it is not clear at this time which services other than those directly related to removing a clot from the graft may be bundled into the new CPT code.

Until that time, G0159 is considered to be the percutaneous equivalent of open surgical procedure codes 36831, 36832 and 36833. The temporary code carries a 90-day global period for the service, which is consistent with the open surgical procedure codes. Because the Health Care Financing Administration (HCFA) has no independent evaluation of the work relative value units (RVUs), the intent of the final rule is that individual local carriers determine pricing, using the open surgical codes for comparison.

The adoption of this temporary code was prompted by the description changes for CPT procedure codes 36860 and 36861 to describe percutaneous thrombectomy procedures, Dorfman explains. Codes 36860 and 36861 now are used correctly for open surgical procedures describing the process of declotting a cannula.

To clarify the issue, he says, the AMA revised 36860 and 36861 in January 1999, adding the word external to both descriptions. But this editorial revision did nothing to address the lack of CPT codes for percutaneous thrombectomy or revision of an arteriovenous fistula.

Professional coders should contact their Medicare carriers, as well as their larger insurance companies or HMOs, to confirm their guidelines regarding this code.

Reader questions were answered by Andrea Lamb, CPC, billing clerk for St. Josephs Medical Plaza, a multispecialty group practice in Buckhannon, W.Va.; and Gary Dorfman, MD, president of Healthcare Value Systems in Rhode Island and past president of the Society for Cardiovascular and Interventional Radiology.