Ask Dr. Z

"Patient with AV fistula presents with steal symptoms (numbness, cramping), and ultrasound demonstrates thrombus in native brachial artery. Fogarty device is used to pull and macerate the thrombus seen into the fistula." Although the physician describes the thrombus as being in the native artery, does the fact that the clot burden was able to be pulled into the fistula signify that this should be coded as 36904 (no fistula conduit thrombus noted or treated)? Or, because it is into the native artery, can it be coded as 37184? (The physician states, "Thrombus will need to be removed, based on ultrasound findings, and no peripheral intervention.") Thank you for clarifying when 37184/36904 should be used!