Radiology Coding Alert

Question: The radiologist punctured the right forearm fistula and performed imaging of the upper arm, axillary, subclavian, and SVC. He also did a right radial artery puncture and radial artery arteriogram was done under ultrasound guidance. There is no documentation of a permanent image for the US guide. How do I report the artery puncture and imaging for the right radial artery?

Codify Member

Answer: For the right radial artery puncture and radial artery arteriogram, look at 36140-59 (Introduction of needle or intracatheter; extremity artery; Distinct procedural service) and 75710 (Angiography, extremity, unilateral, radiological supervision and interpretation). Append modifier 26 to 75710 if you’re reporting only the professional component.

You should append modifier 59 to 36140 to indicate it’s a separate puncture from the one required for the fistula puncture and imaging. The fistula service, including imaging through the superior vena cava (SVC), is reported using 36147 (Introduction of needle and/or catheter, arteriovenous shunt created for dialysis [graft/fistula]; initial access with complete radiological evaluation of dialysis access, including fluoroscopy, image documentation and report [includes access of shunt, injection(s) of contrast, and all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava]).

Rationale: Even assuming the right radial artery is the inflow vessel of the fistula, the separate puncture and imaging should be separately reportable if you have supporting documentation. CPT^® guidelines state: “The arterial inflow to the AV access is considered a separate vessel. If a more proximal inflow problem separate from the peri-anastomotic segment is suspected and additional catheter work and imaging must be done for adequate evaluation, this work is not included in 36147.”