Ask Dr. Z

Please do NOT include any actual patient medical records with your question. Dr Z, two questions regarding av fistula coding I haven’t seen addressed yet. First, how would we code under the most current guidelines, for angioplasty of the arterial inflow (arterial anastomosis is patent) with additional angioplasties within the fistula and outflow vein. Would we consider the inflow part of the fistula and code this as one venous angioplasty or would it be considered arterial and override the venous code? (Don’t think I have enough documentation to consider it a separate stenosis considerably away from the fistula.) Second, I have a case where the fistula is accessed and a fistulagram was performed (36147). Then from a direct access into a collateral an embolization was performed (37204/75894). How should the collateral access be coded? Thanks so much for your help.