Killer tips for coding AV fistula cpt code

Ateriovenous fistula (AV fistula) is a connection between an artery and vein. In AV fistula the blood flows directly from the artery to vein, instead of from artery to capillaries, capillaries to vein. In addition, it is refer as atriovenous shunt created for dialysis. In interventional radiology medical coding, the AV fistula cpt code procedures are more complicated to code. It usually occurs in the extremities.  To study AV fistula, the physician insert a needle with a puncture in the skin. Once the needle reaches the AV fistula, a guide wire is inserted. The catheter is guided over guide wire to study the fistula. Finally, the contrast is injected in AV fistula. The images are captured through fluoroscopic assistance to find the abnormality in AV fistula. Since, the untreated AV fistula can lead to more complex complications. These tips are really important for Certification exams like CPC, you can go through sample CPC questions here which will surely help in clearing CPC exam.

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Killer tips for coding AV fistula or shunt
AV fistula

CPT code for AV fistula

For taking initial access, we have separate CPT code for AV fistula 36147 and for second access, we have an add-on code 36148. In initial access the physician injects the contrast to study the AV fistula. Moreover, the second access is used to perform a therapeutic procedure if there is any complication in AV fistula. Following are the two codes
36147- For initial access in AV fistula, this includes catheter insertion and catheterization of all order vessels in the procedure. Also injection of contrast, injection, local anesthesia and the pre and post injection care.
+36148 - For Second access in AV fistula with the Therapeutic interventional procedure. It also the procedure as with 36147
36148 should always code with 36147. This is only coded when we have a therapeutic intervention procedure performed with second access. If there is no therapeutic procedure performed like stent placement, angioplasty etc., we are not supposed to code this code.

Read also: 36147 AV fistula or graft or shunt


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 Thrombectomy in AV fistula

Formation of thrombus in AV fistula is resolved with Thrombectomy. The Thrombectomy CPT code for AV fistula includes all the minor procedure required for Thrombectomy. The formation of blood clot obstructs the blood flow in AV fistula. To resolve this clot we have to do fragment the clot through thrombolysis. The original procedure involves a catheter, which placed at the site of thrombus. The thrombolytic agent like urokinase injected to break the clot. This will dissolve the clot and thrombolysis takes place. The clot will be fragment and the clot fragment removed through suction. The catheter removed and the pressure is applied.

Blood clot <image credit>

CPT code for Thrombectomy in AV fistula

Thrombectomy in AV fistula include the injection, thrombolysis and mechanical fragmentation of clot. CPT code for Thrombectomy for AV fistula is 36870. Thrombolysis in AV fistula also coded as Thrombectomy.
36870- Percutaneous Thrombectomy in AV fistula includes injection, thrombolysis and mechanical fragmentation of Thrombus.

Angioplasty in AV fistula

Killer tips for coding AV fistula or shunt
Coronary Angioplasty <image credit>
In angioplasty, again a needle inserted to take access. The guide wire used to place the catheter. The catheter guided over the guide wire in the narrowed area of affected vessel. In angioplasty, the catheter covered with the balloon. After the catheter placed in the affected vessel, the balloon is inflated. The inflated balloon increases the narrow area for proper blood flow.  Several inflations are performed for normal flow of blood in the blood vessel.  The catheter is removed after deflation.

Read also: Nephrostomy tube placement cpt code

CPT code for Transluminal Balloon Angioplasty in AV fistula

The cpt code used for the angioplasty depends on the arterial or venous anastomosis. If the angioplasty is done on arterial anastomosis we have to code 35475. If the angioplasty is done on venous anastomosis we have to code 35476. So, the finally the following codes are coded for arterial and venous angioplasty in AV fistula.
For Arterial Angioplasty
35475 – Transluminal Balloon Arterial Angioplasty
 75962 - Supervision and interpretation for other than renal or other visceral artery, iliac or lower extremity.
For Venous Angioplasty
35476 – Transluminal Balloon Venous angioplasty
75978 – Supervision and interpretation for vein.

Stent placement in AV fistula

Stent placement <image credit>

The angioplasty done sometimes does not resolve the problem permanently. The chances of narrowing of artery may be there even after angioplasty. Therefore, we have to go ahead and do Stent placement along with angioplasty for permanent treatment of the problem. Stent placement involves a small mesh wire tube, which is placed along with balloon during angioplasty. The procedure starts by taking an access through the needle. Then guide wire is placed along the needle. The catheter is passed through guide wire. Now, here is the main thing to check. While inserting catheter, along with balloon on the catheter, a small mesh wire tube is placed called stent. The stent is placed above the balloon, when the balloon is inflated the stent expands. This helps in widening the artery. The stent will be placed in expanded position to help in normal flow of blood through the artery. Hence, stent placement decreases the chances of narrowing or artery again.

CPT codes for Stent placement in AV fistula

There are generally two codes used while coding stent placement of AV fistula. The coding totally depends on the arterial anastomosis or venous anastomosis. When the stent placement is on the arterial side of AV fistula we code 37236. When the stent placement is on the venous side of AV fistula we code 37238. The code description is given below.

37236- Stent placement for artery of AV fistula or shunt includes all the angioplasty within the same vessel with supervision and interpretation.
37238- Stent placement for vein in AV fistula includes all the angioplasty within the same vessel with supervision and interpretation.
As you can see through the code description, the Stent placement codes include the angioplasty cpt code also. Hence, never code an angioplasty code along with the Stent placement code. Therefore, whenever there is an angioplasty done along with stent placement in AV fistula, the stent placement cpt code will be enough to bill.

This is the complete guide about coding of AV fistula. The AV fistula coding is considered a little tough. However, if you understand the concept of coding for AV fistula you can easily code these procedures. I have discussed the most common procedures used while coding AV fistula. Hope, you can find this article helpful while coding AV fistula. Please share it if you like it.

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