Ask Dr. Z

Patient has a LUE brachiocephalic AV fistula but due to repeated issues with subclavian vein stenosis a bypass graft was inserted that went from the cephalic vein to the internal jugular vein. Since the subclavian vein is completely occluded, would the peripheral portion of the dialysis graft be from the brachial artery anastomosis to the internal jugular anastomosis with the central portion being the left internal jugular vein through the superior vena cava? Reason being they performed an angioplasty and stenting of the left innominate vein from the AV graft access (36908) and internal jugular angioplasty via the femoral vein access (37248). I know the CPT Codebook 2021 page 309 states if angioplasty or stenosis is performed via a non-AV graft access it is coded with normal CPT, but what if both the stenting of the innominate and angioplasty of the internal jugular were performed via the AV graft micropuncture? Would it be just 36907? Or would it be treated as a regular bypass graft with 37248?