Wiki AVG Thrombectomy

[Robbin109]

1. Mechanical Thrombectomy and balloon angioplasty of the AV graft circuit
2. Balloon angioplasty of Internal Jugular Vein
3. Balloon angioplasty of brachial artery
4. Catheter placement first order vessel brachiocephalic trunk
5. Left upper extremity angiogram

Clotted AVG left brachial artery to jugular vein

Indications
Patient presented with left internal jugular vein to brachial artery AVG, recently clotted.

Wire was advanced into the brachiocephalic trunk.
7 French sheath was then established. Bernstein catheter was then advanced into the brachiocephalic trunk. Angiogram demostrated severe
stenosis at the anastomotic site brachial artery. Using US guidance, I was able to visualize the AV graft again. Again this was repeated into the venous limbs
systems with 6 french sheath. Mechanical thrombectomy using the trerotola device and was then completed with lytic therapy instillation of 4mg. We then subsequently balloon angioplasty the brachial artery and the AV graft. Next, we ballooned angioplastied the internal jugular vein. Hemostasis was excellent and wires removed.

 

[mk2001]

It's been a while since I've coded for an AVG intervention but I think 36905 captures all of the above.

 

[danteeg65]

This is an interesting case Lol, Brachial-Jugular AV fistulas are very uncommon.
I would query the Physician First to make sure the actual AV Fistula is not a Brachial Artery- Cephalic Vein Fistula, (there is no such a thing as a "Left Brachiocephalic Artery, the brachiocephalic trunk is a first order great artery which branches directly off of the aortic arch on the far right.)

So out of the two scenarios if this is indeed a Brachiocephalic AV Fistula, we would code this case as follows.
1) 36905- Thrombectomy and Angioplasty Of the Brachial AVG segment (Peripheral)
2). 36907- Angioplasty Of the Jugular Vein (Central Segment)
3) 76937- U/S Guidance for vascular access procedures. (You must query him to amend this documentation for the U/S guidance portion to support 76937 he must document the vessel site visualized, the vessel entered, and that permanent images were recorded and stored,.

Scenario #2 If this is indeed a Brachial Artery- Jugular Vein AV Graft, and he did selectively engage the Brachiocephalic (Inominate Artery) on the right, he needs to document where the access site vessel was so we can confirm it was a first order selection, also why he imaged the left side brachial portion of the av graft from cath placement in the Brachiocephalic artery on the contralateral side of the body? In that case we would code that as follows-

36905- Brachial Artery/ AV Graft Mechanical Thrombectomy/ Angioplasty. (The Brachial Artery and graft are part of the peripheral segment of the AV Dialysis Circuit)
36215- First Order Selective Catheter placement for the Selection of the Brachiocephalic Artery ( The Brachiocephalic is a native artery proximal to brachial artery used for the graft and outside of the Dialysis circuit and thus native arterial selective catheterization, angiogram and or intervention at the time of AV dialysis fistula revascularization procedures are seperately reportable when medical necessity and guidelines are permissible. (Native arteries outside of the graft artery).
36907- Jugular Venoplasty (The Jugular Vein is part of the Central Segment of the AV Dialysis circuit and add on codes 36907- Central segment angioplasty, 36908- Central Segment Stent placement includes angioplasty when performed).
75710- Extremity angiogram .
76937- U/S Guidance

Hope this helps! Email or reach out if you ever need to with IR/ Vascular coding questions.
Thanks
Erik Brown, CIRCC, CPC
Ernist8489@gmail.com