Wiki New to Vascular coding please help!!

[mjsjeep]

I am new to vascular coding and my doc gave me these codes but I need help with them. I am attaching the OP note. Please let me know what you think?
Any help is appreciated.


DX:ESRD, Failure to mature a fistula

Procedure:
1.Sonosite, Ultrasound guided access of left upper arm cephalic vein antegrade
2.Lt brachiocephgalic fistulogram
3.Coil embolization of large lt venous tributary
4.followup angiogram post embolization
5.radiological interpertation and supervision of above

Patient was placed in the supine position. Following administration of IV sedation, the left arm was prepped with Chloraprep and sterily draped. The proximal cephalic vein had a decreased thrill, therefore,the Sonosite ultrasound guidance was used to access the antegrade with a micropuncture set. An occlusion fistulogram was performed with 2ml of contrastin 6ml of saline. This revealed the above findings. A 4 French sheath was placed, then the diverting tributary was accessed and a 6 mm x 10 cm Boston Scientific interlocked embolization coil was deployed in the diverting tributary. Position was ideal. The coil was deployed using a Canata 2.5 Fr microcatheter. Repeat occlusion fistulogram was demonsrtated the other vessels to be widely patent. The proximal cephalic vein was also widely patent.
A Z stitch was placed at the base of the sheath for hemostasis and the sheath was removed. Pressure was held for hemostasis and dressing was applied.


The codes the doc has given me are:
76937
36147
37204/75984
75989

Any help would be appreciated!!!

 

[CMcFann]

mjsjeep

Your physician's codes are correct except for the last one 75989, the correct code is 75898 for your followup angio of the embolization. So you should code, 37204, 36147, 75984, 75898, and 76937 with your dx of 996.1(for mechanical complication of a renal dialysis access) and 585.6 secondary for your ESRD

Hope this helps!

P.S. Please also make sure that your physician dictates that permanent images are on file for the ultrasound or you cannot bill it out. Per the CPT code and guidelines permanent images are required and a statement documenting this in the op report is required.

 

[BC1957]

Coil placement

I would drop 36147 and code the selective catheterization 36011 and the angiogram of the access 75791-59. 37204, 75894, 75898-59 i would use icd-9 996.73, 585.6

get the asdin manual.....happy coding

 

[mjsjeep]

Thank you for all your help! I will go over it with the doc.