Many old age patients with AV fistula have complications after some time in AV graft. Now, to treat this physician used many therapeutic procedures. Some of the common procedure to treat complication in AV fistula is stent placement, Angioplasty, mechanical thrombectomy etc. These procedures are done only when there is some stenosis, stricture, occlusion etc present in the graft. Now, for performing thrombectomy, there will be the presence of thrombus in AV fistula. So, all in all we are here to learn the CPT codes used for coding these procedures especially the Mechanical thrombectomy.
There is new CPT code 36901 for AV fistula Access and separate procedure for interventional procedures of AV fistula.
The previously used codes (36147, 36148, 36870, 75791, 35476, 75798, 35475, 75962) have been deleted and can no longer be used. From 2017, new codes have been introduced.
Effective from 2017, three codes (36901, 36902, 36903) were created to bundle all work involved in the percutaneous management of a patent dialysis access and three codes (36904, 36905, 36906) were created to bundle endovascular dialysis access thrombectomy procedures. Both code sets are hierarchical and describe increasing intensity of intervention.
In addition, three add-on codes (+36907, +36908, +36909) were created to reflect additional work in the central veins and/ or branch vessel embolization.
image courtesy: http://cirse.org/index.php
Diagnosis used with CPT code for Mechanical thrombectomy
As per my knowledge, if you know the diagnosis you can assume what kind of procedure is done. For example, if there is hemorrhage or bleeding in an artery in diagnosis, most of the time an embolization procedure is performed to block that artery. So, always check for what diagnosis the patient is coming to the physician. Now, here also the most common diagnosis used for all the complication present in the AV fistula is 996.1 in ICD9 and T82.590A in ICD 10.
996.1 – Mechanical complication of other vascular device, implant, and graft
ICD 10 code
T82.590A – Other mechanical complication of surgically created arteriovenous fistula, initial encounter
Now, you can see the difference between ICD 9 and ICD 10 code. These will the common diagnosis used for coding complications in AV fistula.
CPT code for Mechanical Thrombectomy in Fistula
Mechanical thrombectomy is done generally by inserting a catheter with an inflatable balloon attached to its tip into an artery, passing the catheter tip beyond the clot, inflating the balloon, and removing the clot by withdrawing the catheter. The catheter is called Fogarty. So, during coding mechanical thrombectomy do remember to see the device used for treating thrombus. The CPT code used for Mechanical thrombectomy in AV fistula is
36870– Percutaneous Mechanical thrombectomy in AV fistula includes injection, thrombolysis and mechanical fragmentation of Thrombus. (deleted in 2017)
Below codes should be used now AV fistula thrombectomy procedures.
36904 Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural pharmacological thrombolytic injection(s);
36905 with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty
36906 with transcatheter placement of intravascular stent(s), peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the stenting, and all angioplasty within the peripheral dialysis circuit
One important not to remember, Thrombolysis in AV fistula is always coded as Mechanical thrombectomy. Hence, do not get confuse when the physician performs thrombolysis in fistula, go ahead and code mechanical thrombectomy CPT code for AV fistula.