Ask Dr. Z

Patient was in for open thrombectomy of AV fistula followed by angioplasty and stent insertion. Is there an additional code for the stent placement if it was done via open approach? Would code 36903 in addition to 36831 be appropriate? If not, what code do we report, if any? “An incision was made in the medial side of the arm where the patient had an arterial revision in the last week, and then a graftotomy was made in this position and a #4 Fogarty was used to thrombectomize both the arterial and venous limbs. Once this was done, a 7 French introducer sheath was placed into the graft in the venous limb, and a fistulogram was performed. There was a very tight stenosis at the AV graft AV fistula anastomosis and at the venous anastomosis. So, an 8 x 5 cm Viabahn stent was then deployed at both locations. Then, an 8 x 4 balloon was placed over the wire in this position and angioplastied several times to 26 atmospheres."