July 2014 Q & A

Question: AV Fistula Arterial Angioplasty with Venous Stent

I was wondering what the coding protocol would be when we angioplasty the arterial anastomosis and place a stent in the graft venous outflow. Would one procedure override the other, as arterial angioplasty would be coded instead of venous angioplasty? However, since stenting now includes any angioplasty, does it matter that it's arterial anastomosis angioplasty?


Answer:

Only one angioplasty OR stent is allowed in the peripheral zone, from the arterial anastomosis to and including the axillary vein. We only recommend the venous stent placement (37238) in this case. This is well documented in the 2014 CPT Codebook in the dialysis section (pages 217-218 in the Professional Edition). If only angioplasties are done, always code to the arterial anastomosis as the procedure, but when the higher level stent is performed in the same zone, we defer to the stent.