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36870 vs. 36831 with 35476

Date: May 30, 2014

Question:

I have a layered question. First, dictation states "open" thrombectomy with a Fogarty catheter. Physician states an incision is made over the venous side of the shunt and a catheter is used to remove clots. Later, a wire is sent to the arterial side of the shunt. The wire goes into the proximal brachial artery where he removes clot that was blocking the flow right at the anastomosis of the arterial side. Is code 36870 the appropriate code to report? Second, physician states a "venogram that was NOT diagnostic" after the thrombectomy demonstrated a stenosis of the distal basilic vein, axillary vein, and stent in the SVC. Is code 36147 reportable even though it was performed after the thrombectomy? Third, the stenosis at the basilic and axillary was dilated with a balloon. The stent in the SVC is also dilated. Therefore, is it appropriate to report codes 36870, 35476, 75978-26, 35476-59, and 75978-59? What about 36147?

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