Ask Dr. Z

Hello - If an open thrombectomy of an AV graft was performed in the OR and took care of the thrombus, and the patient was then transferred to the CATH lab immediatley after open procedure and angioplasty and stenting was also performed of the AV graft to treat the stenosis causing the thrombolysis. Can we code for all the procedures?

36831 open thrombectomy of AV graft
35476 Angioplasty of AV graft
75978,26
37205 Stenting of AV graft
75960,26

Shouldn't the Dr. have to state that after the angioplasty flow there were suboptimal results therfore they proceded with stenting in order to bill for angioplasty and stenting? Also, can we code for the open thrombectomy with the percutaneous angioplasty and stenting?

Thank you for your help!

We found this in the CMS NCCI guidelines:
7. If a failed percutaneous vascular procedure is followed by an open procedure by the same physician at the same patient encounter (e.g., percutaneous transluminal angioplasty, thrombectomy, embolectomy, etc. followed by a similar open procedure such as thromboendarterectomy), only the HCPCS/CPT code for the completed procedure, which is usually the more extensive open procedure may be reported. If a percutaneous procedure is performed on one lesion and a similar open procedure is performed on a separate lesion, the HCPCS/CPT code for the percutaneous procedure may be reported with modifier 59 only if the lesions are in distinct and separate anatomically defined vessels. If similar open and percutaneous procedures are performed on different lesions in the same anatomically defined vessel, only the open procedure may be reported.