Q&A with Dr. Z: Embolization Dialysis Collateral Vein


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

Question:
Can you please let me know if I coded this correctly? The doctor says I should be able to code the cath placement into the collateral vein and the venogram. I thought it was included in the fistulogram and embolization.

US guided access into left forearm AV fistula (all documentation is there) 76937-26 fistulogram of left radiocephalic AV fistula and Central Venogram – PTA peripheral dialysis circuit in the outflow vein. 36902 Selective catheterization of lateral collateral vein arising from the peripheral juxta anastomotic outflow vein (included in embolization ?) Venogram of selected collateral forearm vein ( billable?) Embolization of selected collateral forearm vein 36909. My doctor asked me to verify with you.

Answer:
Ultrasound guidance for vascular access (76937) is reportable when documented per CPT requirements with access to a dialysis circuit (including realtime access and documentation of a permanent recorded image). The imaging of the dialysis circuit is included in the venoplasty in the peripheral segment (CPT code 36902). Do not report 36901. All catheter placements to perform the embolization of collateral veins preventing maturation of a fistula is bundled with embolization add-on CPT code 36909. Do not report selective venous catheter placement codes 36011 or 36012 when embolizing branches of the AV dialysis circuit.

The correct CPT codes here are 36902 and +36909.

 

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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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