Q & A with Dr. Z: Arch, Upper Extremity, or AVF?

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC

Question:
How would you code this case? 36221, 36902, 0237T?

Pre/post op diagnosis: left AV fistula inflow stenosis.

Description: The right common femoral artery was accessed using a micropuncture needle. This was exchanged for 5 French sheath using Seldinger technique. A pigtail catheter was advanced into the ascending aorta and arch angiogram was performed. Please see above findings for details. Next the left subclavian artery was selectively catheterized and a left upper extremity angiogram and left upper extremity fistulogram was performed. 5 French short sheath was exchanged for 5 French 90 cm sheath positioned in the left brachial artery. The proximal left brachial artery was subsequently balloon anigoplastied using a 4 x 60 drug coated ranger balloon. Completion angiogram and fistulogram revealed widely patent left radial artery without residual stenosis.

Findings: high grade proximal left radial artery stenosis successfully treated with atherectomy and balloon angioplasty.

Answer:
Code 36221 describes the arch imaging, 36216 describes the left brachial artery catheter placement, and 37246 describes angioplasty of the brachial artery. Code 36902 is not used, as the dialysis circuit was not accessed. This is an angioplasty of the brachial artery. An atherectomy (0237T) was not done.

 

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Disclaimer: This article is written for educational purposes only. Every reasonable effort has been made to ensure its accuracy and completeness. It is the responsibility of the reader to refer to the definitions, descriptions, conventions, and guidelines specific to each coding classification, as well as relevant laws and regulations when selecting and reporting medical codes.

About the Author

David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC
David Zielske is founder and President of ZHealth Publishing and primary author and editor of ZHealth publications. Dr. Z practiced as an interventional radiologist and has over twenty years experience as a coding reviewer and coding expert. He is Board Certified in Radiology and has functioned as an independent interventional radiology, vascular surgery, and cardiovascular coding consultant to a variety of physician groups and hospital providers across the country. He also served as an instructor for over 200 coding seminars.

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