Ask Dr. Z

It is my understanding that if, after the creation of an AV fistula, a vein transposition is performed at a later surgical session on the same fistula, that this should be reported with code 36832 (revision of AV fistula) instead of codes 36818-36820 for vein transpositions. My physicians disagree, stating that performing the vein transposition requires significantly more work than other, more simple revision procedures, and they believe the work RVU is more consistent with codes 36818-36820. They don't agree that the description in the CPT Codebook correlates to a one- or two-stage procedure and think they should use it in either scenario. I am hoping you can shed some more light from a clinical perspective that can assist me in explaining to them why this procedure should be coded this way.