General Surgery Coding Alert

Answer: CPT 2001 now includes 36870 (thrombectomy, percutaneous, arteriovenous fistula, autogenous or non-autogenous graft [includes mechanical thrombus extraction and intra-graft thrombolysis). As of Jan. 1, 2001, this code should be used to report thrombectomies of AV fistulas, says Diane Elvidge, CPC, a coding and reimbursement specialist with Princeton Reimbursement Group in Minneapolis.

Now, providers are instructed to use G0159 (percutaneous thrombectomy and/or revision, arteriovenous fistula, autogenous or nonautogenous dialysis graft). G codes are temporary HCPCS codes.

Code 36870 is valued at 36.23 relative value units (RVUs) in a non-facility setting and 8.07 RVUs when performed in a hospital or outpatient clinic/ambulatory service center. But, local Medicare carriers may have the final word on coverage, so check with your carrier to see if they pay for this new procedure and, if so, how they want it coded.

For peripheral artery clot removals, an unlisted code, 37799 (unlisted procedure, vascular surgery), should be used, Elvidge says. When billing 37799, the description AngioJet should be noted in Item 19 of the Health Care Financing Administration (HCFA) 1500 claim form or, for electronic claims, on the free form line.

Nationwide, Medicare carrier coverage and reimbursement policies on AngioJet differ, with only a few carriers publishing guidelines for AngioJet use. The inclusion of 36870 in CPT 2001 should help the campaign by Possis to urge Medicare and private payers to cover the procedures, Elvidge says.