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Discontinued procedure?

  1. Default Discontinued procedure?
    Medical Coding Books
    Would you bill 36147 or 36147-74 (I am billing for the facility).

    I felt this was a discontinued procedure....???? Thanks, Sue


    Preoperative diagnosis: Malfunctioning right upper extremity AV fistula

    Postoperative diagnosis: Thrombosed right upper extremity AV fistula

    Procedure: Right upper extremity fistulogram


    Indications for procedure: This is a 61-year-old male with a right basilic vein transposition fistula through which he performs home dialysis. There was difficulty accessing his fistula and fistulogram was requested.

    Details of the procedure: The patient was identified and placed supine on the angiography table. The right arm was prepped and draped in the usual sterile fashion. After injection of 2% lidocaine, the right arm fistula was attempted to be accessed with a micropuncture needle. This was found to be very difficult; therefore, ultrasound guidance was employed for fistula access. Images were saved for documentation. Ultrasound images noted the very proximal part of the fistula near the arterial anastomosis appeared to be patent; however, the remainder of the fistula appeared thrombosed. Needle was inserted under ultrasound guidance into the fistula where some blood return was obtained. Wire access was attempted; however, this was not successful. Contrast run through the needle was performed and noted patent brachial artery; however, there did not appear to be any flow in the fistula. At this point the procedure was terminated with plans for operative revision and possible tunneled catheter placement. Manual compression was used for hemostasis. The patient tolerated the procedure well with no immediate complications.

    Findings:
    1. Patent right brachial artery.

    2. Thrombosed right basilic vein transposition AV fistula.

  2. #2
    Default
    In billing for the facility, you would code the 36147-74 since the procedure was started with anesthesia but then discontinued due to not being able to complete the procedure.
    Hope this helps!!!
    Amy Pritchett,
    BSHA, CPC, CPMA, CPC-I, CDEO, CANPC, CEDC, CASCC, CRC, CMDP, CMPM, CCS, CMRS, C-AHI, ICDCT-CM, ICDCT-PCS
    2017-2018 Secretary of Local Mobile AAPC Chapter
    2015-2016 President of Local Mobile AAPC Chapter

  3. Default
    I guess my question would you consider this discontinued not a full diagnostic procedure. I feel it was discontinued but one of my co-workers says it was diagnostic.
    thanks!

  4. #4
    Default
    There is documentation that the physician tried twice with two separate tools to get into the artery and could not maneuver. Therefore, the fistula was not revised. This is not a diagnostic procedure in my eyes. I would still code the -74 modifier.
    Amy Pritchett,
    BSHA, CPC, CPMA, CPC-I, CDEO, CANPC, CEDC, CASCC, CRC, CMDP, CMPM, CCS, CMRS, C-AHI, ICDCT-CM, ICDCT-PCS
    2017-2018 Secretary of Local Mobile AAPC Chapter
    2015-2016 President of Local Mobile AAPC Chapter

  5. Default
    Thank you!

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