Help with Angioplasty

ksnively

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Hoping someone can help me with angioplasty of an AV graft. I am getting confused regarding the central and peripheral zones.

The physician performed a balloon angioplasty of the axillary vein-AV graft junction and then placed a stent in the axillary vein-AV graft junction for persistent stenosis. He also did angioplasty of the subclavian vein.

Would I code 37205/75960 and 35476/75978 for the axillary vein-AV graft junction and also 35476/75978 for the subclavian vein or do you only code the 35476 once?

Thank you for your help!
Kim
 

jtuominen

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The AMA published some clarifying points on the the two AV shunt "territories" in their 2012 CPT code book errata that might help you:

►Interventions for Arteriovenous (AV) Shunts Created for Dialysis (AV Grafts and AV Fistulae): For the purposes of coding interventional procedures in arteriovenous (AV) shunts created for dialysis (both arteriovenous fistulae [AVF] and arteriovenous grafts [AVG]), the AV shunt is artificially divided into two vessel segments. The first segment is peripheral and extends from the peri-arterial anastomosis through the axillary vein (or entire cephalic vein in the case of cephalic venous outflow). The second segment includes the veins central to the axillary and cephalic veins, including the subclavian and innominate veins through the vena cava. Interventions performed in a single segment, regardless of the number of lesions treated, are coded as a single intervention.

They should really have a picture of this in the codebook, shouldn't they?!

URL for this text is: http://www.ama-assn.org/resources/doc/cpt/cpt-corrections.pdf


So I would say in relation to you situation:

For the AV Graft Junction/axillary Vein Stenosis: Code for 35476/75978 and 37205/75960, as long as your documentation states that the intial intent was to attempt to treat the diseased area with PTA, and the results were unsatisfactory, so stenting was performed over the same area, with improved results. If it doesn't read that way, and the PTA reads more like pre-dilation, with the stent being the definitive treatment, don't code for the PTA.

Subclavian Vein Stenosis: Charge for an additional 35476/75978, because this intervention occured in a seperate territory from your first treatment area.

I hope this helps. Have a good day!
 
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