Wiki Fistulogram coding

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Fistulogram Coding

See 36901, 36902, 36903, 36904, 36905, 36906. CPT® 36901-36903 cover procedures with the introduction of a needle, either within a dialysis circuit, transluminal balloon angioplasty, or intravascular stent insertion. CPT® 36904-36906 cover procedures under mechanical thrombectomy through a dialysis circuit, transluminal balloon angioplasty, or intravascular stent insertion.

CPT® 2017 introduced the above codes under the added subhead “Dialysis Circuit,” along with several pages of definitions and instructions to apply the new codes properly. The dialysis circuit is created to allow easy, repeated access to blood vessels to perform hemodialysis (removing blood from the patient’s body, cleansing it to replace/supplement the function of the kidneys, and returning it to the patient’s body). CPT® separates the dialysis circuit into two components: The peripheral dialysis segment and the central dialysis segment. Both are defined within the instructions provided under the Dialysis Circuit subhead.

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vkratzer

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Need some help with CPT coding for a fistulogram. Also, physician did angioplasty of axillary veins. Would it be correct to use 35476.

Appreciate any advice.

Thanks. Vicky
 

heathermc

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We use 75790-26 for the fistulagrams, but you need to read the op note and make sure it was in the fistula itself and not the vein, in which case 75820-26 would be appropriate. As for the angioplasty, that is the correct code if it is done percutaneous. You would also use 36870 for the declot and 36145 for the introduction of the cath percutaneous. But if they made and incision and all this is done open, we use 36833, 35460-51 and 75978-26. Hope this helps.
 

nc_coder

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We do angios of fistulas all the time. I wasn't aware there were G codes for this. When would I need to use them instead of the CPT codes?
 

Shirleybala

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G0392 Transluminal balloon angioplasty, percutaneous; for maintenance of hemodialysis access, arteriovenous fistula or graft; arterial

G0393 Transluminal balloon angioplasty, percutaneous; for maintenance of hemodialysis access, arteriovenous fistula or graft; venous

If angioplasty done in graft use these codes.

Be sure to code the catheterization of the limbs in addition to therapeutic procedures. If both the arterial and venous sides are both punctured, 36145 would be reported twice. You may need modifier –59 with this. It is also called “fistulogram.”
Report S&I code 75790 for imaging

Code S&I 75790 includes imaging of outflow to the level of the right atrium. Do not report the 75825 vena cavagram S&I and 75820 extremity code with this. It is included.
Angioplasty of AV fistula use 35476 + 75978 or G0393 + 75978 for Venous PTA of AV graft Medicare or G0392 + 75962 for Arterial only PTA for of AV graft Medicare .

Zones for AV Graft/Upper

Upper Extremity

Zone 1: Arterial anastomosis, intra-graft, venous anastomosis and outflow veins to axillary vein
Zone 2: Subclavian and brachiocephalic veins (central extremity veins)
Zone 3: Superior Vena Cava
Only one venoplasty per zone

can be reported in this

Interpretation.

Zones for Lower Extremity

Lower Extremity

Zone 1: Arterial anastomosis, intra-graft to venous anastomosis (common femoral vein)
Zone 2: External iliac and common iliac veins (central extremity veins)
Zone 3: Inferior Vena Cava
Only one venoplasty per zone can be reported
 
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