graft ?? any takers

heart123

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the patient was brought to the operating room and was placed supine with arms at 90 degrees. The patient was given antibiotics and left upper extremity, left shoulder and the left chest was prepped and draped in the usual sterile fashion. Attention was then turned to the left arm. 2 cm longitudinal incision was created over the graft. Dissection down to the graft was made and the graft was exposed and was encircled with a vessel loop. After heparinization transverse graftotomy was made and the proximal and distal thrombectomy with 2 and 3 Fogarty balloons were done with expression of large amount of thrombus. Backbleeding and forward bleeding was then seen. An 8 French sheath was placed and graft angiograms were obtained both proximal and distal showing patency of the graft and the stent all throughout including the arterial anastomosis. The graftotomy was then closed with 5-0 Prolene interrupted sutures. The whole length of the graft was then inspected with a duplex ultrasound and was found to be patent with good waveforms. 36831,36901 ??? if so what else do i have thanks TIA
 

cpc2007

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Good morning, assuming this is an AV graft, I would agree with 36831 for the thrombectomy. If this is a graft other than an AV graft (e.g., a bypass graft), I would code 35875. I would not code 36901 with 36831 because CPT guidelines state "If open dialysis circuit creation, revision, and/or thrombectomy (36818-36833) are performed, completion angiography is bundled, as is peripheral segment angioplasty and/or stent placement (36901, 36902, 36903) and, therefore, not separately reported." So that angiogram at the end is not billable with 36831. The same would be true of 75710 with 35875 if this is a graft other than an AV graft.

With that said, the documentation supports either 36831 if this is an AV graft or 35875 if this is a graft other than an AV hemodialysis graft (e.g., bypass graft). I hope that helps!

Kim
www.codingmastery.com
 
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