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Second Opinion on Coding Fistula Intervention

  1. #1
    Location
    Columbus, Ohio
    Posts
    77
    Default Second Opinion on Coding Fistula Intervention
    Medical Coding Books
    Here is the note of the procedure only:
    OPERATIVE SUMMARY: First, 1 % lidocaine was infiltrated at the distal-most
    portion of the fistula. An 18-gauge thin-walled needle was then introduced.
    A short 6-French sheath was placed. Next, by compressing the outflow of the
    fistula, the arterial anastomosis was imaged. Next, remaining portion of the
    fistula and central veins were imaged. This demonstrated a bifid cephalic neck. No hemodynamically significant stenosis in side branches, in the midportion and distal fistula. Next using a covered stent, mid portion of the fistula and side branch were covered. Next. the more distal side branch was then coiled with four 8 mm coils. Completion film demonstrated marked improvement. The covered stent, I believe will allow the apex to fill the fistula. It was also marked. We can start using it immediately. The patient tolerated the procedure well. There were no complications.

    __________________

    I read this to be an intervention with the stent and an embolization with the coils because of the use of the words "mid" and "distal". Therefore coding this as 37241 37236-59 36147.
    I am aware that stents can be used with coils to "provide latticework for coil deployment" which means I would not report the stent but the provider does not mention that.

    What do you think? Please provide rational for your response. Thanks for your help.

  2. #2
    Default
    Quote Originally Posted by stephanie7480 View Post
    Here is the note of the procedure only:
    OPERATIVE SUMMARY: First, 1 % lidocaine was infiltrated at the distal-most
    portion of the fistula. An 18-gauge thin-walled needle was then introduced.
    A short 6-French sheath was placed. Next, by compressing the outflow of the
    fistula, the arterial anastomosis was imaged. Next, remaining portion of the
    fistula and central veins were imaged. This demonstrated a bifid cephalic neck. No hemodynamically significant stenosis in side branches, in the midportion and distal fistula. Next using a covered stent, mid portion of the fistula and side branch were covered. Next. the more distal side branch was then coiled with four 8 mm coils. Completion film demonstrated marked improvement. The covered stent, I believe will allow the apex to fill the fistula. It was also marked. We can start using it immediately. The patient tolerated the procedure well. There were no complications.

    __________________

    I read this to be an intervention with the stent and an embolization with the coils because of the use of the words "mid" and "distal". Therefore coding this as 37241 37236-59 36147.
    I am aware that stents can be used with coils to "provide latticework for coil deployment" which means I would not report the stent but the provider does not mention that.

    What do you think? Please provide rational for your response. Thanks for your help.
    I would bill for the shunt access and an embolization. The stent used is a covered stent, which can be used for embolization (covers the side branches).
    HTH,
    Jim Pawloski, CIRCC

  3. #3
    Location
    Columbus, Ohio
    Posts
    77
    Default
    Thanks Jim, that is what I actually ended up doing. 37124 and 36147 only. I appriciate your feedback.

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