Ask Dr. Z

Ultrasound guidance is used frequently for access to dialysis AV fistulas/grafts. Coding 76937 is allowed if all the elements of the code are documented and only "when the AV graft or fistula is documented as either immature or failing". Immaturity is usually well documented. When would the AV graft or fistula be imaged and have some type of intervention performed if it is not failing? Is thrombus, stenosis, etc. found during the fistulogram treated with angioplasty, stent, thrombectomy enough to consider it failing? Is there specific documentation needed, or can 76937 be coded if an intervention is performed?