Q & A July 2020 

Question: Embolization Dialysis Collateral Vein

Can you please let me know if I coded this correctly? The doctor says I should be able to code the cath placement into the collateral vein and the venogram. I thought it was included in the fistulogram and embolization.

US guided access into left forearm AV fistula (all documentation is there) 76937-26 fistulogram of left radiocephalic AV fistula and Central Venogram - PTA peripheral dialysis circuit in the outflow vein. 36902 Selective catheterization of lateral collateral vein arising from the peripheral juxta anastomotic outflow vein (included in embolization ?) Venogram of selected collateral forearm vein ( billable?) Embolization of selected collateral forearm vein 36909. My doctor asked me to verify with you.

Congrats to our AAPC HealthCon winners from last week!

Helena Polk, CPC - CIRCC Study Guide
Gary Chan, MD - Interventional Radiology Coding Reference
Linda King, CPC, CPCO, CPC-I, CCVTC, CEMC, CGSC- Vascular & Endovascular Surgery Coding Reference
Sheila Russell - Diagnostic & Interventional Cardiovascular Coding Reference
Kelly Brian - Cardiothoracic Surgery Coding Reference
Dana Dayries, CPC - Diagnostic Radiology Coding Reference

March 2018 Q & A

Question: 36904

How would you bill for crisscross infusion catheters placed in a AV dialysis fistula? Fistulogram showed thrombus within AV fistula with total occlusion. Successful crisscross placement of 5 F sheath and 10 cm infusion catheter within the venous limb directed peripherally and 6 French with 10 cm infusion catheter within the arterial limb directed centrally.

February 2018 Q & A

Question: Single Lead Pacemaker Generator Change

1. Pacemaker generator change 2. Placement of a new lead in the right ventricle 3. Capping and abandonment of old lead. When the existing right ventricular lead has been capped and abandoned and new lead is advanced into the right ventricular apex using a combination of straight and custom-formed stylettes onto new pacemaker generator, (pulse generator was also changed), should this procedure be coded as 33212, 33216, 33233? Or 33227 with 33212 and 33216, and is fluoroscopy always included in a pacemaker procedure?

January 2018 Q & A

Question: Peripheral Angiography with a Cardiac Cath

Left heart catheterization is ordered for a patient with unstable angina. The Op report states that the patient also has a small ulcer on the foot, a history of atherectomy of the SFA, and reassuring ABI. Catheterization is performed via a right radial artery access. Subsequently, the catheter is moved down to right common femoral artery where runoff of the right leg with digital subtraction at 2 levels is performed. CFA is normal and arthrectomy site is patent. Would this be coded 93458, 36247, 75710?