Radiology Coding Alert

Bolster your interventional coding with this thrombectomy example "Thorough" is the name of the game when it comes to IR coding. We'll walk you step by step through this complicated scenario to make sure you don't miss any opportunity for reimbursement.
 
The first step: Put your interventional radiology (IR) skills to the test with this clinical example of a clotted AV (arteriovenous) graft provided by Deepa Malhotra, CPC, president of Healthcare Educational Resource Services (HERS Inc.) in Chicago. Procedure performed: tPA, angioplasty, and thrombectomy.
 
Patient was brought to the angiogram suite and put in a supine position. Left arm was prepped and draped in sterile fashion. Skin was infiltered with 2 percent lidocaine. 18 gauge angiocath was inserted into the graft. 2,500 units of heparin was injected. 20,000 units of urokinase was infused for an hour. Guide wire was passed through, and a 7 French sheath was placed. Graft-venous anastomosis was crossed, and central veins were evaluated. Left axillary vein, subclavian vein, innominate vein and SVC are patent and unremarkable. Graft-venous anastomosis is to the antecubital vein. The main draining veins are the left basilic and brachial veins. Left cephalic vein occludes about 2 inches above the elbow joint. Graft-venous anastomosis is mildly stenotic. There are multiple severe intragraft stenoses. Graft venous anastomosis and intragraft stenoses were dilated with 6-mm and 7-mm balloon.
 
Since there is no flow in the graft, puncture was made in the graft toward the arterial end. Arterial anastomosis was crossed with a Benston wire, and a 6 French was placed. Using a 5 French over the wire, Fogarty balloon arterial plug was removed. Subsequent venogram shows multiple filling defects through the graft, which were then removed using Teratola Basket. Postprocedure venogram shows good flow through
the graft. Challenge Yourself to Find All the Codes What to do: Whenever you have a procedure like this, start by confirming that it actually took place within a dialysis graft, says Donna Richmond, CPC, RCC, a radiology coding expert with CodeRyte Inc.
 
And pay particular attention to when the report says "injection" or "infusion" to be sure you correctly identify the procedure, Malhotra says.
 
Once you know this, you can be sure 36145 (Introduction of needle or intracatheter; arteriovenous shunt created for dialysis [cannula, fistula, or graft]) is the right code for the inserted angiocatheter, Malhotra says. But don't report separate codes for the injection of heparin or infusion of urokinase, she says.
 
Instead, your next code will be an S&I code for the shunt evaluation (75790, Angiography, arteriovenous shunt [e.g., dialysis patient], radiological supervision and interpretation).
 
Watch for: Code 75790 includes all imaging of the graft and venous outflow, says Danette Jones, CPC, RCC, CIC, with Central Kentucky Radiology. Don't [...]