36147 and 36148

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Manchester, NH
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I know that if there is a second access to an AV fistula we use the 36148, but is this true if it is a truly a separate puncture after a diagnostic fistulogram or can we use 36148 when a new sheath is put in for an angioplasty.

Using standard aseptic technique under 1% Lidocaine local, 18 gauge Angiocath was inserted in draining vein of the left forearm dialysis AV fistula. Injection demonstrated patent arterial venous anastomosis but significant stenosis involving draining vein 3 cm above anastomosis.

Informed consent was obtained. Using standard aseptic Seldinger technique under 1% Lidocaine local anesthesia, the existing Angiocath was exchanged over a guidewire for 6 French sheath.......


He then goes on to describe a venous angioplasty. Is the exchange over a guidewire considered a second separate access - 36148? Would appreciate any help.
 

Jim Pawloski

True Blue
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1,247
Location
Ann Arbor
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I know that if there is a second access to an AV fistula we use the 36148, but is this true if it is a truly a separate puncture after a diagnostic fistulogram or can we use 36148 when a new sheath is put in for an angioplasty.

Using standard aseptic technique under 1% Lidocaine local, 18 gauge Angiocath was inserted in draining vein of the left forearm dialysis AV fistula. Injection demonstrated patent arterial venous anastomosis but significant stenosis involving draining vein 3 cm above anastomosis.

Informed consent was obtained. Using standard aseptic Seldinger technique under 1% Lidocaine local anesthesia, the existing Angiocath was exchanged over a guidewire for 6 French sheath.......


He then goes on to describe a venous angioplasty. Is the exchange over a guidewire considered a second separate access - 36148? Would appreciate any help.
No, same access. They just switched the catheter for a vascular sheath.
HTH,
Jim Pawloski, CIRCC
 
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