Forum - Questions & Answers

Jun 17th, 2009 - codinguser9 1 

Please check this coding

Here's the situation: Thrombosed left arm arteriovenous graft: outpatient procedure

Physician passed a guidewire through the venous anastomosis into the subclavian vein, with using a catheter in order to inject to confirm patency of the subclavian and axillary vein. Two areas of stenosis was discovered whereupon the physician inserted a balloon which was inflated through the brachial vein to the distal portion of the graft to macerate the thrombus. Next the physician accessed the graft in the direction of the arterial anastomosis, again a guidewire with balloon this time through the brachial artery. A fistulogram was performed. A tretola device was advanced through both the venous and arterial outflows to remove residual thrombus. A balloon angioplasty across the venous anastomosis was performed, with repeated images. That's the abrdiged description of the procedure; hope I provided enough detail.

My question: Is the below listed coding correct and complete for this procedure:

36870,35476,35476-59,36145,36145-59,75790,75978


Jun 17th, 2009 - nmaguire   2,606 

A-V Graft

just a few notes for you to recheck with the op-note:
If the patient comes to the angiographic suite with needles in place (ie, from the dialysis center), 36145 would not be coded
PTA codes are used per vessel, not per lesion. Multiple stenoses may be treated with PTA but venous PTA is coded only once. A balloon angioplasty of the arterial anastomosis is coded as a venous angioplasty because it is considered part of the same vessel as the graft and outflow vein. It is important to note that the second venous angioplasty may be coded if there is a separate and distinct stenosis in the central vein(s), this may require documentation by some payers. Veins
more central than the axillary vein are considered separate vessels, example, a stenosis in the subclavian vein or vena cava that needs to be treated may be coded as a second venous angioplasty (ie, 35476, 75978) with modifier -59..
The codes look good but I never say for certain before seeing a procedure note

Jun 17th, 2009 -

Please check coding - AV graft

I would really need to see the full report to code correctly. It doesn't specify how the first access was gained--that is a key piece of information. I can't determine what code should be assigned for that...

Right now I have 36145, 75790, 36870, 35476 (or G0393 if hospital coding), 75978. Of course my recommendations might change if I could see the case in its entirety.

When balloon is used to macerate thrombus it isn't counted as a PTA-- it is bundled with the thrombectomy.

I don't see any documentation that indicates they actually treated the stenosis outside the graft to pick up additional PTA's.

You may send me the full report if you like.

Stacie L. Buck, RHIA, CCS-P, RCC, CIC
President/Senior Consultant
RadRx "Your Prescription for Accurate Coding & Reimbursement”
Email: sbuck@radrx.com
Phone (772) 287-8849
EFax (772) 408-4083

Jun 18th, 2009 - codinguser9 1 

Check my coding reply

Thanks to all for your reponses. Stacie, I will certainly send you the report for your review.



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