Ask Dr. Z

Dear Dr. Z, we've got a case that's challenging my understanding of the new dialysis graft/fistula codes. Your comments & advice would be welcome. CLINICAL DATA: PT W/HX OF RT.FOREARM LOOP GRAFT AND RT. UPPER ARM AV GRAFT, REFERRED FOR EMBOLIZATION OF RT.FOREARM LOOP GRAFT AS WELL AS DIAGNOSTIC FISTULOGRAPHY OF RT.UPPER ARM AV GRAFT. Procedures performed: 1. Retrograde access of rt.forearm loop graft. 2. Diagnostic fistulogram. 3. Selection of axillary artery & performance of a rt. upper extremity arteriogram for eval. of brachial artery. 4. Amplatz embolization of arterial limb of rt. forearm loop graft. 5. Antegrade access of right upper arm AV graft. 6. Diagnostic fistulogram of rt. upper arm AV graft 7. PTA of venous anastomosis with an 8mm balloon. 8. Removal of sheath & catheters and hemostasis obtained w/manual compression. (Note:I have not typed out the body of the report because physician did such a good job in this procedure heading list, but if you need, will be glad to provide) I've arrived at these CPT codes: 37204 + 75894; 36147, 75658-59 for study/work on forearm graft. 36147(?-59) and 35476 + 75978 for study/work on upper arm graft. My question: 36147 did not edit out in our Encoder when coded x2; do you think it will be correct to submit x2 since pt has 2 different grafts in one arm? Also do you agree with 75658-59 for studying brachial artery? Did not code 36120 since brachial artery not directly punctured; axillary artery selected after retrograde access in rt forearm loop graft. Any suggestions you have would be appreciated. THANKS SO MUCH FOR YOUR HELP! :D