Q & A with Dr. David Zielske

Question: Stenosis vs Clotted AV Fistula

Coding guidelines state that when an intervention is performed on an AV Fistula, the arterial and venous sides are considered one vessel. It's understandable when a stenosis exists and requires just one wire to be placed, but I was wondering if there was an exception when a clot is encountered since 2 wires are placed and 2 sides are ballooned/stented?


Answer

If a clot is removed or cleared, code 36870 applies. This includes removing/clearing the clot with a balloon catheter. Code 36870 is reported one time. Angioplasty and stent placement for stricture (not clot) in two sides of a graft are coded as treatment of a single anatomical site. For example, angioplasty with suboptimal results followed by stent placement to treat stenoses in the arterial limb and in the venous outflow of the graft are reported as one venoplasty and one stent placement. (Note: in 2013 the venoplasty having suboptimal results is reported separately. This changes in 2014, as the new stent placement codes include all angioplasty.) If the angioplasty was at the arterial anastomosis and the stent was placed in a vein in the extremity, code the arterial angioplasty and the stent placement (in 2014 only the stent placement can be coded). From the arterial anastomosis through the graft, up to and including the axillary vein, coding rules allow a single intervention to be coded, as this entire area is considered a single vessel for coding purposes.