Radiology Coding Alert

Question: May I report vascular angioplasty separately from 36870?

Connecticut Subscriber

Answer: Yes, you may report these two services on the same claim. The Correct Coding Initiative (CCI) considered bundling these services but decided not to.

Rationale: According to the AMA's CPT Assistant (May 2001), 36870 (Thrombectomy, percutaneous, arteriovenous fistula, autogenous or nonautogenous graft [includes mechanical thrombus extraction and intra-graft thrombolysis]) "includes all the work required to remove the thrombus from the access, declot the graft, and restore flow to the access." You should use the appropriate component codes describing other portions of the percutaneous procedure separately, CPT Assistant states.

Example: A Society of Interventional Radiology (SIR) letter, opposing the angioplasty/thrombectomy bundle, states that the potential components, depending on your case, include the following:

• accessing the graft/fistula (36145, Introduction of needle or intracatheter; arteriovenous shunt created for dialysis [cannula, fistula, or graft]) which you may report twice for two separate punctures

• diagnostic fistulogram including imaging of the entire access and outflow during the procedure (75790, Angiography, arteriovenous shunt [e.g., dialysis patient], radiological supervision and interpretation)

• balloon angioplasty of the graft or fistula and the outflow vein(s) (35476, Transluminal balloon angioplasty, percutaneous; venous, and 75978, Transluminal balloon angioplasty, venous [e.g., subclavian stenosis], radiological supervision and interpretation, for non-Medicare payers; or G0393, Transluminal balloon angioplasty, percutaneous; for maintenance of hemodialysis access, arteriovenous fistula or graft; venous, and 75978 for Medicare)

• balloon angioplasty of an arterial inflow stenosis (35475, ... brachiocephalic trunk or branches, each vessel, and 75962, Transluminal balloon angioplasty, peripheral artery, radiological supervision and interpretation, for non-Medicare payers; or

G0392, ... arterial, and 75962 for Medicare)

• balloon angioplasty of a distinctly different central venous stenosis in the subclavian vein or superior vena cava (35476 and 75978).

Resource: You can find this letter online at http://members.sirweb.org/members/coding/CCIdialysisdec26_DH_endorsed.pdf.

Note: The 2001 CPT Assistant also describes stent placement (37205, 75960) and pharmaceutical thrombolysis outside the graft (37201, 75986, plus catheterization codes) as separately reportable.