Ask Dr. Z

Patient presents with upper arm clotted AV fistula. Antegrade and retrograde punctures were made (36147, 36148). Thrombolysis was performed with tPA followed by balloon maceration (36870). Follow-up imaging demonstrates poor flow in radial artery with small embolus (about 3 inches from anastomosis, but not documented as such). Radial artery was catheterized, and suction thrombectomy was performed (36215 and 37186???). Lower extremity arteriogram was then performed, which shows sluggish flow to hand (75710??). Infusion catheter was inserted half into radial artery and half into fistula for six-hour thrombolysis therapy (37211). My questions are, would you charge for the secondary thrombectomy (36215 and 37186) and consider the extremity angio to the hand to be follow-up imaging? Or, would you consider going after the small embolus as part of the AV fistula thrombectomy but then charge codes 36215 (delete 36148) and 75710 for the diagnostic arteriogram to hand, and then commence with 37211 for arterial thrombolysis? I am thinking codes 36147, 36870, 36215, 75710, and 37211.