Ask Dr. Z

I am wondering if we can code 76937, 76937-59 for AV fistula cases that document US vascular access like this: "Under ultrasound guidance the AV graft was accessed in both antegrade as well as retrograde direction using a micropuncture needle. Needle entry was confirmed using real time ultrasound guidance and permanent ultrasound images were obtained and stored for documentation, for both the antegrade and retrograde accesses." Also, later under "FINDINGS" documentation states: "Initial US images demonstrate a thrombosed left upper extremity AV graft from the AV anastomosis to the venous anastomosis."

I am hesitant to code 76937 x 2 due to both accesses were into the same AV graft. I am also not sure if this is preferred technique or medical necessity.