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Thread: Angioplasty AV fistula

  1. #1

    Default Angioplasty AV fistula

    Hi all:

    If a angioplasty is done in an AV fistula i am submitting the codes 35476 and S&I 75978.And our physician is accepting these codes.

    But when we have to use G0393 , G0392 and what are the S&I for these codes (because these codes clearly explains 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)

    Please Advice
    Shirley CPC,CPC-H

  2. #2

    Default

    you would use the same S&I codes (75978 or 75962)

  3. #3

    Default AV fistula angioplasty

    Because the graft is considered and extension of the host vessel (vein) the graft is venous. Therefore, the imaging guidance code is 75978.

  4. #4

    Default 35476 Vs G0393

    Hi,

    For angioplasty of AV fistula which code we have to use ,35476 or G0393 which is the apt code for billing.And which code are you all using.
    Shirley CPC,CPC-H

  5. #5

    Default

    for angioplasty of an AV fistula, I use 75978/G0393 in most cases. sometimes it's the 75962/G0392 (arterial angioplasty)

  6. #6

    Default Angioplasty

    The G0393/75978 Venous Are Billed To Medicare And 35476/75978 To All Other Carriers And G0392/75962 Arterial Billed To Medicare And 35475/75962 To Other Carriers
    This Is How I Bill And Have Not Had A Problem Getting Paid
    Hope It Helps

  7. #7

    Wink

    Yes! Shirley! G0393 is used for medicare patients and 35476 for other insurance holders.

    Lingaraj

  8. #8

    Default

    Thankyou lingaraj
    Shirley CPC,CPC-H

  9. #9

    Question

    I'm a little confused by the HCPCS code. We have done this procedure for years and I have never heard of this code. I have done some research on it and found that the G code should be used for Medicare patients. However, I went back and looked at some of our cases where we have filed 35476 to Medicare. We have been paid with no problem using the CPT code instead of the HCPCS. Also, on the fee schedule, the 2 codes have the same allowable. So, my question is, why do you have to use the G code? What difference does it make? When we don't use the HCPCS code for our screening colonoscopies, we get denials. That doesn't seem to be the case with this one. Can someone please enlighten me?

  10. #10

    Default

    The G codes are for Medicare reporting of PTA's for maintenance of hemodialysis access, arteriovenous fistula or graft...

    When PTA of the AV-fistula or graft is performed on a Medicare beneficiary, the G-codes should be utilized and not the CPT codes (i.e. 35476). When a venous or arterial PTA is performed on a Medicare beneficiary outside of the AV-fistula the appropriate CPT code may be utilized. One must take into account what is considered inclusive of the AV fistula (zones).

    Payment for the CPT code when reported for PTA of the AV-fistula or graft does not mean that the claim was submitted appropriately.

    G0392/75962
    G0393/75978

    Hope this helps...
    Anthony McCallum, CPC, CIRCC, CPC-I, CCS
    ciphermed@optonline.net

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