kvo
Networker
I am trying to supply supporting documentation to a physician who is questioning why I am not coding for a thrombectomy within a fistula. He feels that an injection of anesthetic is an attempt to a thrombectomy and should be coded with a modifier of reduced services. Following is the report. I am interested if anyone agrees with my coding and if so some direction as to where to find documentation to support this.
"Informed consent was obtained including a detailed description of the risks and benefits of an AV fistula venogram with possible intervention including the risk of damage to the fistula. The patient's access and extremity were prepped and draped in sterile fashion using chloraprep solution. The skin overlying the access was infiltrated with 1% lidocaine. Micropuncture technique was used ot cannulate the proximal portion of the access near the arterial inflow. A sheath was inserted over wire and a catheter advanced over the wire. Contrast was injected to perform a diagnostic fistulogram.
The graft is thrombosed from the arterial anastomosis to the axillary vein, at the site of a chronic axillary venous occlusion. Because there is no venous outflow, thrombectomy could not be performed.
At this point, all catheters and wires and sheaths were removed. Pressure was applied and hemostasis was obtained. The patient tolerated the procedure well and was sent to recovery.
Impression: Unsuccessful A/V graft thrombolysis secondary to chronic axillary venous occlusion."
I coded 36147 only.
The physician would like it coded 36870-52, 36147.
Any input is appreciated. Thank you.
Kim R. Vo, CPC, CIRCC
"Informed consent was obtained including a detailed description of the risks and benefits of an AV fistula venogram with possible intervention including the risk of damage to the fistula. The patient's access and extremity were prepped and draped in sterile fashion using chloraprep solution. The skin overlying the access was infiltrated with 1% lidocaine. Micropuncture technique was used ot cannulate the proximal portion of the access near the arterial inflow. A sheath was inserted over wire and a catheter advanced over the wire. Contrast was injected to perform a diagnostic fistulogram.
The graft is thrombosed from the arterial anastomosis to the axillary vein, at the site of a chronic axillary venous occlusion. Because there is no venous outflow, thrombectomy could not be performed.
At this point, all catheters and wires and sheaths were removed. Pressure was applied and hemostasis was obtained. The patient tolerated the procedure well and was sent to recovery.
Impression: Unsuccessful A/V graft thrombolysis secondary to chronic axillary venous occlusion."
I coded 36147 only.
The physician would like it coded 36870-52, 36147.
Any input is appreciated. Thank you.
Kim R. Vo, CPC, CIRCC