Radiology Coding Alert

The Health Care Financing Administrations (HCFA) final rule for Medicare reimbursement begins the process of clarifying correct coding for percutaneous declotting procedures.

The final rule, as reported in the Nov. 2, 1999, Federal Register, announces a temporary Level II HCFA Common Procedure Coding System (HCPCS) code: G0159percutaneous thrombectomy and/or revision, arteriovenous fistula, autogenous or nonautogenous dialysis graft.

According to Gary Dorfman, MD, FACR, FSCVIR, representative to the American Medical Associations (AMA) CPT advisory committee and president of Healthcare Value Systems in Rhode Island and past president of the Society for Cardiovascular and Interventional Radiology, G0159 pertains to percutaneous thrombectomy of a dialysis graft or fistula. It describes percutaneous declotting by any methodincluding mechanical devices, lyse and wait, and short infusion.

Code G0159 will be used until the AMA creates a permanent CPT Code , expected no sooner than 2001, according to Dorfman. It is possible that more than one code may ultimately 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 analogous to open surgical procedure codes 36831 (thrombectomy, arteriovenous fistula without revision, autogenous or nonautogenous dialysis graft [separate procedure]), 36832 (revision, arteriovenous fistula; without thrombectomy, autogenous or nonautogenous, dialysis graft [separate procedure]) and 36833 (revision, arteriovenous fistula; with thrombectomy, autogenous or nonautogenous dialysis graft [separate procedure]).

The temporary code carries a 90-day global period for the service, which is consistent with the open surgical procedure codes. Because HCFA had 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.

Background: Clarifying 36860 and 36861

Adoption of this temporary code was prompted by the elimination of CPT procedure codes 36860 (external cannula declotting [separate procedure]; without balloon catheter) and 36861 (external cannula declotting [separate procedure]; with balloon catheter) to describe percutaneous thrombectomy procedures, Dorfman explains. Codes 36860 and 36861 are now correctly used 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. However, this editorial revision did nothing to address the lack of CPT Codes for percutaneous thrombectomy or revision of an arteriovenous fistula.

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