Ask Dr. Z

2017 CPT book, P247, “Codes 36907 and 36908 describe procedures performed through puncture(s) in the dialysis circuit. Similar procedures performed from a different access (e.g., common femoral vein) may be reported using 37248, 37249 or 37238, 37239.” 2017 CPT book, P255, continues to say “37248 and 37249 describe transluminal balloon angioplasty in a vein excluding the dialysis circuit (36902, 36905, 36907) when approached through the ipsilateral dialysis access.” I am confused about these two instructions. Can I understand in this way, for example, in a patient with dialysis circuit, if central dialysis segment angioplasty (e.g., external iliac vein) is performed through puncture in the common femoral vein, shouldn’t the procedure be coded with 36907 instead of 37248? Because the procedure is performed through dialysis circuit. (common femoral vein is part of the peripheral dialysis segment, which is part of the dialysis circuit). Only when the procedure is done in veins other than in the dialysis circuit, should the code 37248 be used?