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Unsuccessful fistulagram

  1. Default Unsuccessful fistulagram
    Medical Coding Books
    Would you bill the fistulagram with a modifier, 36147-74 and the duplex ultrasound 93990? I don't feel the fistulagram is billable since access was unsuccessful. Also would you apply a 74 modifier to 93990?




    78 year old male with malfunctioning left upper extremity AV fistula who had already undergone an intervention 2 months ago.


    Risks and benefits of the procedure were discussed with the patient and informed consent was obtained. The patient was placed supine on the angiographic table and the left upper extremity was prepped and draped in the usual sterile fashion. 2% lidocaine was administered for local anesthesia and intravenous analgesia was administered. His prior fistulogram from June was reviewed.

    Attempt was mad to access the arterial limb of the graft with a micropuncture needle unsuccessfully. Each time blood return was achieved through the needle the 018 micropuncture guide wire was not able to be advanced. At this point I performed a duplex ultrasound on the fistula which showed that is was chronically occluded. There was a proximal stump open, however, at the level of a scab over the fistula the vessel was noncompressible with echogenic contents. Due to the quality of the this access and not wanting to send emboli into this already frail patients pulmonary vasculature, I elected to abort the procedure and explore other access options.


    Chronically occluded left upper extremity AV fistula.


    Unsuccessful dialysis fistulogram.

  2. #2
    Roxboro/Durham NC
    I would only code the ultrasound 93990 since access was never obtained.

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