Wiki Need clarification on AV Fistula Interventions

[kvo]

Could someone verify my coding for this procedure? It is an AV Fistulogram with interventions. This is for a right radiocephalic AV fistula. The report is lengthy so I will summarize.
1) first cannulation with diagnostic fistulogram (36147)
2) due to findings, venous angioplasty of the venous limb of access
3) second cannulation (36148)
4)thrombectomy of arterial anastomosis (36870)
5) selective cath of radial artery outside of fistula (36215) with arteriogram (75710)
6) juxta anastomotic arterial segment angioplasty (35475, 75962)
7) stent placement in venous limb of access (37238)

Since angioplasty of the venous and arterial in the peripheral segment are performed only the arterial is reported but I am not finding anything stating not to report the venous stent in the peripheral in addition to the arterial angioplasty. ??????

 

[jkayser]

The CPT book states that "the same rules used for angioplasty apply to stent placements for AV dialysis shunts with respect to the number of interventions reported for each patient. Either 37236 or 37238 is reported once to describe all work of stenting lesions within the defined AV dialysis shunt segment from the peri-arterial anastomosis through the axillary and cephalic veins, regardless of the number of stents placed or the number of discrete lesions treated within that vessel segment."

EncoderPro shows no CCI conflict between 35475 for brachiocephalic trunk or branches arterial angioplasty and 37238 for venous stent placement.

Like you, I could not find any documentation indicating that these cannot be billed together. To accurately code this situation, I agree with you that both 35475 and 37238 should be coded.

 

[dpeoples]

The CPT book states that "the same rules used for angioplasty apply to stent placements for AV dialysis shunts with respect to the number of interventions reported for each patient. Either 37236 or 37238 is reported once to describe all work of stenting lesions within the defined AV dialysis shunt segment from the peri-arterial anastomosis through the axillary and cephalic veins, regardless of the number of stents placed or the number of discrete lesions treated within that vessel segment."

EncoderPro shows no CCI conflict between 35475 for brachiocephalic trunk or branches arterial angioplasty and 37238 for venous stent placement.

Like you, I could not find any documentation indicating that these cannot be billed together. To accurately code this situation, I agree with you that both 35475 and 37238 should be coded.

I agree that both 37238 and 35475/75962 should be billed. I would be reluctant to bill 36215/75710. That is likely part of the av fistula anatomy and is included with 36147 and 36148.

HTH

 

[kvo]

Thank you for the input! Much appreciated!