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Angioplasty-Do we need to

  1. Default Angioplasty-Do we need to
    Medical Coding Books
    Do we need to code CPT 35475(radial artery angioplasty) & 75962 for the below procedure in addition to 35476 & 75978-26 or does inflow radial artery angioplasty is included in 35476 itself????Kindly confirm...

    History: 63 year old male with end-stage renal disease on
    hemodialysis presents with poor flows from his left radio cephalic
    native dialysis fistula following hemodialysis.

    Procedure in brief: AV shunt study, brachial artery angiogram,
    percutaneous angioplasty of inflow radial artery stenosis,
    percutaneous angioplasty of arteriovenous anastomotic stenosis,
    percutaneous angioplasty of outflow antebrachial vein stenosis,
    ultrasound guidance

    Procedure and Findings:

    After administering local anesthesia to the overlying soft tissue,
    crossing 7 French vascular sheaths were placed into the fistula
    outflow vein in the forearm under real-time ultrasound guidance.
    Contrast injection with digital imaging of the left arm and chest
    in the frontal projection was performed. A 4 French Berenstein
    catheter and a hydrophilic guide wire were advanced through the
    sheath, guided beyond the arteriovenous anastomosis and positioned
    within the inflow brachial artery. A brachial artery angiogram was

    These images demonstrate patency of a small caliber inflow radial
    artery. Severe, irregular narrowing is identified extending from
    the arteriovenous anastomosis through the juxta anastomotic
    outflow venous segment for approximately 4 cm in length. In
    addition, moderate narrowing of the outflow vein extends for an
    additional 6 cm in length. Moderate narrowing is identified within
    the outflow antebrachial vein just below the elbow. The outflow
    basilic vein in the upper arm is widely patent.The central outflow
    veins are patent.

    After crossing the venous outflow with a floppy guidewire, the
    antebrachial venous stenosis was dilated using an 8 mm x 8 cm
    angioplasty balloon. The juxta anastomotic stenosis was
    sequentially dilated using 6-mm and 8mm by 4-cm Cordis
    angioplasty balloons. The inflow radial artery extending for
    approximately 6 cm in length was sequentially dilated using a 5 mm
    x 4 cm and 6 mm x 4 cm Cordis Extreme angioplasty balloons. An
    improved thrill was palpated within the fistula outflow vein at
    this time. A final angiogram was performed demonstrating
    demonstrating brisk flow through the fistula with minimal residual
    irregularity at the angioplasty sites. The sheaths were removed
    and hemostasis was obtained with manual compression.

    Angiographic evaluation of left radiocephalic native dialysis
    fistula demonstrating inflow radial artery arteriovenous
    anastomotic, juxta anastomotic and outflow venous stenoses as
    described above. The central outflow veins are widely patent.

    Successful percutaneous angioplasty of the above mentioned lesions
    using 5 mm, 6 mm and 8 mm diameter high pressure angioplasty
    balloons as described above.
    Prabha CPC

  2. #2
    Melbourne, FL
    They have just changed, again, the codes for arterial and venous angioplasty of a fistula. You are to charge the arterial fistula 35475 and 75962-26 and 36147-51. The angioplasties appear to be within the peripheral zone. (Code arterial only as of June I think before it was venous)

  3. #3
    United Aram Emirates
    Can code 35475/75962 for angioplasty of the upper extremity AV fistula/graft arterial anastomosis and for a native brachial, radial, ulnar, subclavian, or brachiocephalic artery stenosis significantly away from the arterial anastomosis. Code 35475 may be used twice if separate and distinct lesions of the native artery and the arterial anastomosis are treated at the same setting.

    I think you are correct. no documentation for stenosis of arterial anastamosis, would code both.

    Harish, CPC, CCS
    Last edited by harish; 08-22-2010 at 11:28 PM.

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