coding of procedures in interventional nephrology: overview of changes in the 2010 revision
TRANSCRIPT
![Page 1: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/1.jpg)
Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision
![Page 2: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/2.jpg)
Vessel Definitions
![Page 3: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/3.jpg)
Central versus Peripheral
• The anatomy texts do not contain a definition of central and peripheral veins
• Central veins– Upper - Veins within the boney thorax– Lower – Veins within the boney pelvis
• Peripheral veins– Veins of extremity up to central veins
![Page 4: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/4.jpg)
Definition of Access
• The vascular access is considered to be a separate vessel by definition
• It extends from the arterial anastomosis through to the beginning of the central veins, i.e., the subclavian
• The arterial anastomosis with the adjacent 2 cm of artery is defined as the arterial portion of the access
• The entire remainder of the access is defined as the venous portion for coding purposes
![Page 5: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/5.jpg)
Coding Changes for 2010
• New codes• 36147 – Cannulation and access angiogram• 36148 – Second cannulation for therapeutic purposes• 75791 – Angiogram of access without cannulation
• Code deletions• G0392 – Arterial angioplasty within access• G0393– Venous angioplasty within access• 36145 – Non-selective cannulation• 75790 – Angiogram of access
![Page 6: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/6.jpg)
Coding Access Angioplasty
![Page 7: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/7.jpg)
New Policy Guidelines
• In 2006 CMS issued two new G codes take effect on January 1, 2007– Venous angioplasty – G0393– Arterial angioplasty – G0392
• These have been discontinued, we are to back to using the old standard codes– Venous angioplasty – 35476 – Arterial angioplasty - 35475
![Page 8: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/8.jpg)
Potential Confusion
• There are special regulations that relate to angioplasty within the access
However• 35475 and 35476 must be used for all angioplasty
both outside of and within the access
• Good documentation is important
![Page 9: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/9.jpg)
Multiple Angioplasties
![Page 10: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/10.jpg)
Within the Access
• Situations in which multiple angioplasties may be coded are very limited
• Although multiple lesions may be present within the access one is permitted to use only a single code
• If these multiple treatments within the access are all venous, then a single venous angioplasty code, 35476, should be used
• If both an arterial angioplasty (arterial anastomosis) and a venous angioplasty are performed within the access, only the arterial treatment should be coded using 35475
![Page 11: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/11.jpg)
Vessels Outside the Access
• Any lesion present within a distinctly separate central venous structure, warrants a separate code - 35476
• Treatment of a lesion within a distinctly separate feeding artery warrants a separate code - 35475
• A separate supervision and interpretation code, 75978 (for venous) or 75962 (for arterial), should be paired with each of the angioplasty codes
• The second venous (within the central veins) or arterial angioplasty (within the feeding arteries) should have a -59 modifier attached as should the second venous S&I code
• The second arterial angioplasty has a different S&I code, 75964
![Page 12: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/12.jpg)
Coding Multiple Angioplasties
• No more than two angioplasty codes should be used in any case• This could be
– one arterial (for the anastomosis or a feeding artery) and one venous (for a central venous lesion)
– two venous - one in the access and one central– two central and none in the access– Two arterial (the anastomosis and a feeding artery, or two feeding
artery)• Any time two angioplasty codes are used very good
documentation should be supplied to explanation the rational for the two codes
![Page 13: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/13.jpg)
Contiguous Lesions
• If a single lesion extends across two adjacent separate vessels, treatment warrants only a single angioplasty code
• In instances in which the exact anatomical identity of the vessel is critical for coding purposes, a lesion that bridges across two vessels should be defined by the vessel in which it lies predominantly
• Two codes are warranted only in instances in which separate distinct lesions are present in separate vessels, provided that the two vessels qualify for separate coding based upon the access versus central veins rule as described
![Page 14: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/14.jpg)
Changes In Cannulation Codes
![Page 15: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/15.jpg)
Basics
• Cannulation or catheterization may be either selective or non-selective• Selective cannulation is a column 1 code and non-selective is a column
2 and these two codes are mutually exclusive• The most frequently performed cannulation is non-selective• The target vessel is entered directly and no further manipulation is
required• This cannulation can be performed under two circumstances –
– Non-selective cannulation to perform an angiogram of the access– Non-selective cannulation for a therapeutic intervention
• With the new regulations, these two procedure types should be coded differently
![Page 16: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/16.jpg)
Non-selective cannulation for purposes of an access angiogram
• The code 36147 is a new code for 2010• This code bundles an angiogram of the access with a
non-selective cannulation performed for the purpose of performing the study
• This code is specific for the dialysis access (either fistula or graft)
• Not an appropriate code for use when a vein is cannulated as for vein mapping
• 36145 and 75790 have now been discontinued
![Page 17: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/17.jpg)
Non-selective cannulation for therapeutic purposes
• If a non-selective cannulation of the access is performed for the purpose of performing a therapeutic intervention, another new code, 36148, should be used
• This would be used for the second cannulation done for a thrombectomy, for example
![Page 18: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/18.jpg)
Selective catheterization (cannulation)
• A selective catheterization code cannot be used with a nonselective code for the same site
• The selective code should be treated as a column 1 code and the nonselective as a column 2 code and the two are mutually exclusive
• Two situations:– Only one non-selective cannulation – list only the angiogram (discussed
further below)– A second nonselective cannulation is performed - this should be dropped in
favor of selective code• The basic principle is - each time a site is used for a selective
catheterization, a non-selective code is dropped in favor of the selective one
![Page 19: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/19.jpg)
Restrictions On Selective Catheterization
• Only selective catheterization of a first or second order artery is allowed– 36215 & 36126 (36245 in lower extremity)
• Selective catheterization of venous side branches is considered to be bundled with 36147– 36011 & 36012 can not be used
![Page 20: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/20.jpg)
Angiogram of Access
• An angiogram of the access can actually be coded three different ways depending upon the individual situation:– Angiogram performed with cannulation – Angiogram only• Angiogram performed through a pre-existing cannulation of
access • Separate angiogram of access code without a cannulation code
– Separate coding of angiogram components
![Page 21: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/21.jpg)
Angiogram Performed With Cannulation
• Already discussed on slide 16• The code 36147 bundles an angiogram of the access
with a non-selective cannulation performed for the purpose of performing the study
• This code is specific for the dialysis access (either fistula or graft)
• All catheter insertion and manipulation within the access is bundled except as listed for selective catheterization of an artery
![Page 22: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/22.jpg)
Codes Bundled With 36147
• 36145 – Cannulation of access• 75790 - Angiogram of access • 76000 - Fluoroscopy (separate procedure) up to one hour
physician time• 75820 - Venography, extremity, unilateral• 75825 - Venography, caval, inferior, with serialography • 75827 - Venography, caval, superior, with serialography• 36140 – Cannulation of extremity artery (excludes brachial)• 36010 – Selective catheterization of superior or inferior vena
cava
![Page 23: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/23.jpg)
Angiogram Only
• 75791 should be used for an access angiogram when a cannulation is not performed
• This code should not be used except where the angiogram is being coded without an accompanying non-selective cannulation– Angiogram performed through a pre-existing cannulation
of access – Separate angiogram of access code without a cannulation
code
![Page 24: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/24.jpg)
Angiogram performed through a pre-existing cannulation of access
• Occasionally the patient presents to the angiography suite with a needle or catheter already in place.
• In this instance, the access does not require cannulation in order to perform the angiogram.
• In this instance the code 75791 would be used for the procedure.
![Page 25: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/25.jpg)
Separate angiogram of access code without cannulation code
• How can the cannulation code in the 36147 bundle be dropped while maintaining the angiogram coding
• This should be done by listing the angiogram as a separate study using the code 75791
• If a second cannulation for therapeutic purpose, code 36148, has been the site of the selective catheterization, it would simply be dropped in favor of the selective code
• Remember that neither 36147 nor 36148 can be used together with 75791
![Page 26: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/26.jpg)
Separate coding of angiogram components
• In order to qualify as a separate procedure and be coded separately, the angiogram must be performed by cannulating a separate site, a site that is not part of the access as defined
• 75820 or 75827, should be listed with a -59 modifier• In this setting 36147 should not be coded (no
reason)• A cannulation for therapeutic purposes may be done
![Page 27: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/27.jpg)
SUMMARY AND CONCLUSIONS
![Page 28: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/28.jpg)
• New regulations have been scheduled to begin January 1, 2010
• Important that the interventionalist dealing with dialysis access procedures become familiar with these and become accustomed to their application
• As is always the case there is very likely to be confusion initially before the changes become infused throughout the system
![Page 29: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/29.jpg)
• A complete copy of the new manual may be obtained from the “Members Only” websites of either ASDIN or RPA
• Use of uniform coding practices and consistently following a set of standardized recommendations such as those represented in the Coding Manual is very important
• It is only by doing this that our Society will be able to speak in the future with a strong, unified voice in matters that relate to this very important aspect of our rapidly growing field
![Page 30: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/30.jpg)
Illustrative Cases for Coding
![Page 31: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/31.jpg)
Tunneled Catheter Placement
There are no changes in coding in this category of procedures
![Page 32: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/32.jpg)
Angioplasty of Venous Stenosis
Uncomplicated
![Page 33: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/33.jpg)
History
• 64 year old male• Polycystic kidney disease• Dialysis for 5 years• Loop graft in left arm• Referred for low flow
![Page 34: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/34.jpg)
Physical Examination
• Loop graft in left forearm• Hyper-pulsatile• Augmented well• Prominent thrill at venous anastomosis• High pitched bruit at venous anastomosis, diastolic
component diminished
![Page 35: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/35.jpg)
Stenosis at anastomosis
![Page 36: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/36.jpg)
Draining veins normal
![Page 37: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/37.jpg)
Central veins normal
![Page 38: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/38.jpg)
SVC normal
![Page 39: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/39.jpg)
Graft, anastomosis and artery - normal
![Page 40: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/40.jpg)
Angioplasty performed
![Page 41: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/41.jpg)
Results of treatment
![Page 42: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/42.jpg)
Coding of Case
2009• 36145 - Cannulation• 75790 - Angiogram of access • G0393 - Venous angioplasty • 75978 - S & I for G0393
2010• 36147 - Cannulation with
angiogram • 35476 – Venous angioplasty• 75978 – S&I for 35476
![Page 43: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/43.jpg)
Angioplasty
Venous and arterial problem
![Page 44: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/44.jpg)
History
• 48 year old male• On hemodialysis for 3 years• Left forearm loop graft• Has 10% recirculation• Poor flow
![Page 45: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/45.jpg)
Examination
• Left forearm loop graft• Augments poorly• Thrill at venous anastomosis
![Page 46: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/46.jpg)
Stenosis at venous anastomosis
![Page 47: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/47.jpg)
Cephalic normal
![Page 48: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/48.jpg)
Central veins normal
![Page 49: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/49.jpg)
Angioplasty done with 8 X 4 balloon
Lesion dilated completely with no residual
![Page 50: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/50.jpg)
Stenosis of arterial anastomosis
![Page 51: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/51.jpg)
Next Step
• Graft cannulated second time on arterial side
• Arterial anastomosis dilated with 6 X 4 balloon
![Page 52: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/52.jpg)
Post angioplasty
![Page 53: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/53.jpg)
Coding of Case
2009• 36145 - Cannulation of graft • 75790 - Angiogram of graft • 36145-59 - 2nd cannulation • G0393 , 75978 - Venous
angioplasty • G0392 , 75962 - Arterial
angioplasty • 74710 - Arteriogram
2010• 36147 – Cannulation and access
angiogram• 36148 – Second cannulation for
therapeutic purposes• 35475 , 75962 - Arterial
angioplasty • 74710 - Arteriogram
![Page 54: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/54.jpg)
Graft With Poor Flow
Venous angioplasties and SVC angiogram
![Page 55: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/55.jpg)
History
• 50 year old male with forearm loop graft• Referred for decreased flow• Has had previous central venous catheters
![Page 56: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/56.jpg)
Physical Examination
• Graft was hyper-pulsatile• Collateral veins on upper arm and chest
![Page 57: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/57.jpg)
Anastomosis stenosis
![Page 58: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/58.jpg)
Basilic stenosis
![Page 59: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/59.jpg)
Brachiocephalic vein stenosis
![Page 60: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/60.jpg)
Next Step
• After multiple attempts, a guidewire was passed across the innominate lesion
• A catheter was passed across the lesion • Superior vena cava angiogram and angiogram of
central veins was performed through catheter
![Page 61: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/61.jpg)
Central veins and SVC angiogram
![Page 62: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/62.jpg)
Basilic angioplasty with 8 X 4
![Page 63: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/63.jpg)
Anastomosis angioplasty with 8 X 4
![Page 64: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/64.jpg)
Angioplasty with 12 X 4
![Page 65: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/65.jpg)
Post treatment result
![Page 66: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/66.jpg)
Inflow Evaluation
• The flow in the graft as tested with a bolus of radiocontrast appeared to be excellent
• The graft augmented well
• Conclusion good inflow
![Page 67: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/67.jpg)
Arterial anastomosis
![Page 68: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/68.jpg)
Coding of Case
2009• 36010 - Selective
catheterization of SVC • 75790 - Angiogram of graft • 75827-59 - Angiogram of SVC • G0393, 75978 - Venous
angioplasty • G0393 -59, 75978-59 - 2nd
venous angioplasty • 35476 , 75978 - 3rd venous
angioplasty
2010• 36147 - Cannulation and access
angiogram• 35476 , 75978 - Venous
angioplasty • 35476 -59, 75978-59 - 2nd
venous angioplasty
![Page 69: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/69.jpg)
Thrombectomy
Arterial embolus
![Page 70: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/70.jpg)
History
• The patient is a 47 year old male• Left upper arm straight graft• Referred for thrombectomy
![Page 71: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/71.jpg)
![Page 72: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/72.jpg)
Stenosis of anastomosis
![Page 73: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/73.jpg)
![Page 74: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/74.jpg)
![Page 75: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/75.jpg)
• Thrombectomy done in standard manner• No difficulties encountered initially• With use of Fogarty patient began to appear
uncomfortable• Examination revealed that hand was cold and the
radial pulse that had been present earlier was now gone
![Page 76: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/76.jpg)
Arteriogram
Done via catheter inserted into brachial artery – selective catheterization
![Page 77: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/77.jpg)
Arterial Embolectomy
![Page 78: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/78.jpg)
Coding of Case
2009• 36145 - Cannulation • 75790 Angiogram of graft • 36870 - Thrombectomy • G0393 , 75978 - Venous
angioplasty • 36215 - Selective
catheterization of 1st order artery
• 75710 - Arteriogram • 37186-59 - Embolectomy,
brachial
2010• 36147 – Cannulation and access
angiogram• 36870 - Thrombectomy • 35476, 75978 - Venous
angioplasty • 36215 - Selective
catheterization of 1st order artery
• 75710 - Arteriogram • 37186-59 - Embolectomy,
brachial
![Page 79: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/79.jpg)
Poor Flow in Fistula
Juxta-Anastomotic Stenosis
![Page 80: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/80.jpg)
History
• 48 year old male• Radial-cephalic fistula• Fistula is 2 years old• History of difficult cannulation• Poor flow
![Page 81: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/81.jpg)
Physical Examination
• Radial-cephalic fistula in right arm• Poorly palpable in upper portion• Did not augment very well• Apparent juxta-anastomotic stenosis
![Page 82: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/82.jpg)
Initial Angiogram
![Page 83: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/83.jpg)
Angioplasty #1
![Page 84: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/84.jpg)
Angioplasty #2
![Page 85: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/85.jpg)
Post - angioplasty
![Page 86: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/86.jpg)
Coding of Case
2009• 75790 - Angiogram of fistula • G0392 , 75962 - Arterial
angioplasty • G0393 , 75978 - Venous
angioplasty • 36215 – selective
catheterization of 1st order artery
• 75710 - Arteriogram of extremity
2010• Angiogram of access without
cannulation - 75791• 35475, 75962 – Arterial
angioplasty• 36215 – selective
catheterization of 1st order artery
• 75710 - Arteriogram of extremity
![Page 87: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/87.jpg)
Poor Development of Fistula
Accessory vein
![Page 88: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/88.jpg)
History
• 32 year old male• Fistula created 6 months earlier• Fistula used for two months• Very difficult to cannulate
![Page 89: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/89.jpg)
Physical Examination
• Radial-cephalic fistula– High anastomosis
• Strong thrill at anastomosis• Fistula not palpable above mid humerus level• Low accessory vein apparent by physical exam
![Page 90: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/90.jpg)
Catheter across anastomosis
![Page 91: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/91.jpg)
Angiogram of accessory vein
![Page 92: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/92.jpg)
Coil in place
![Page 93: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/93.jpg)
Radiocontrast through catheter in accessory vein
![Page 94: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/94.jpg)
Final angiogram
![Page 95: Coding of Procedures in Interventional Nephrology: Overview of changes in the 2010 revision](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649c855503460f9493c19a/html5/thumbnails/95.jpg)
Coding of Case
2009• 75790 – Angiogram of access• 36011 – Selective
catheterization of first order vein
• 37204 – Placement of embolization coil
• 75894 - Radiological S & I for 37204
• 75898 – Follow-up angiogram for coil embolization
2010• 36147 – Cannulation and
access angiogram• 37204 – Placement of
embolization coil• 75894 - Radiological S & I for
37204• 75898 – Follow-up angiogram
for coil embolization