Wiki Angioplasty and Stent / can i report both?

[stephanie7480]

I know the rules for the lower extremities but I am not clear if it applies to the upper the same. Here is what happened.
Access to fistula. Fistuaogram performed. (36147) Then catheter was advanced and central veins angioplastied. (35476,75978) next catheter was pulled back to upper arm and thrombectomy was performed and stent placed over same lesion (37187,37238) after this a second catheter was placed retrograde through this newly placed stent and wire was passed through brachial artery, another fistulogram performed demonstrating additional clot. Which was in the arterial side of the graft. This was ballooned and stented.
I know I can only code for one stent placement since the graft through the central veins is considered a single segment and I an code only one angioplasty CPT for all the angioplasty done in a single segment but can I code one of each (1 angioplasty and 1 stent) if performed and on different lesions? If you have a link to a reference to support your response that would be additionally helpful to back up my coding selections.
CPT only says "The same rules that apply to angioplasty apply to stent placement with respect to the number of interventions performed for each patient.
Thanks for your help!!
Stephanie W, CPC

 

[dpeoples]

I know the rules for the lower extremities but I am not clear if it applies to the upper the same. Here is what happened.
Access to fistula. Fistuaogram performed. (36147) Then catheter was advanced and central veins angioplastied. (35476,75978) next catheter was pulled back to upper arm and thrombectomy was performed and stent placed over same lesion (37187,37238) after this a second catheter was placed retrograde through this newly placed stent and wire was passed through brachial artery, another fistulogram performed demonstrating additional clot. Which was in the arterial side of the graft. This was ballooned and stented.
I know I can only code for one stent placement since the graft through the central veins is considered a single segment and I an code only one angioplasty CPT for all the angioplasty done in a single segment but can I code one of each (1 angioplasty and 1 stent) if performed and on different lesions? If you have a link to a reference to support your response that would be additionally helpful to back up my coding selections.
CPT only says "The same rules that apply to angioplasty apply to stent placement with respect to the number of interventions performed for each patient.
Thanks for your help!!
Stephanie W, CPC

Stephanie,
The codes for stent placement include angioplasty in the same vessel. The codes are based on vessel treated, not lesion treated. I would not code for angioplasty/venoplasty in the above scenario.
Also, please reference the CPT book for descriptions of transcatheter procedures, and specifically mechanical thrombectomy. " For mechanical thrombectomy for dialysis fistula, use 36870".


HTH