Basics for Cpt code for Fistulogram

An abnormal connection between artery and vein is called as arteriovenous fistula. Generally, it is created for hemodialysis treatment. AV fistula is very important in medical coding. Medical coders have to know everything about AV fistula before coding CPT code for fistulogram or AV fistula. Cpt Code for fistulogram is used very frequently and it has high dollar value. Hence, coders have to code CPT codes of fistula very carefully. Let us learn more about fistulogram or AV fistula or shunt.

CPT code for AV fistula Access 36901 have been added in 2017.

Procedure for CPT code for fistulogram

To study an AV fistula, the physician inserts the needle or catheter into an arteriovenous (AV) fistula or shunt through the skin. AV fistula is created generally on patients who are on dialysis. The catheter is guided into the fistula and toward to area to be treated. Once the catheter reached to target area contrast is injected into it. Films are taken after injecting the contrast to find any abnormality present in the AV Fistula. Cpt Code for fistulogram is coded as per the procedure performed in the fistula.

When to use CPT code for Fistulogram 36901, 36902 & 36903

The physician inserts a needle or catheter into a dialysis circuit via a puncture in the skin overlying the circuit of a dialysis patient. The catheter is guided into the circuit and vessel to an area upstream of the site under investigation, and contrast material is injected into it. CPT code 36901 is reported for the initial access, including shunt access, contrast injections, and all fluoroscopic imaging deemed necessary from the arterial anastomosis and adjacent artery through the entire venous outflow (inferior and superior vena cava included).

For CPT code 36902, a catheter with a balloon attached is inserted into the peripheral dialysis segment and fed into the narrowed portion where its balloon may be inflated several times in order to stretch the diameter, allowing a more normal flow of blood through the area.

For CPT code 36903, a catheter with a stent-transporting tip is threaded over the guidewire into the peripheral dialysis segment and the wire is extracted. The catheter travels to the point where the vessel needs additional support. The compressed stent is passed from the catheter into the vessel, where it deploys, expanding to support the vessel walls. Once the procedure is complete, the catheter is removed and pressure is applied over the puncture site.

The CPT code 36901, 36902 & 36903 have replaced the old CPT code 362147 & 36148 in 2017. The initial access to the fistula is coded with the CPT code 36901 and any therapeutic intervention like angioplasty or stent placement will be coded using CPT code 36902 & 36903. Below is the description of these codes.

36901

Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava, fluoroscopic guidance, radiologic supervision and interpretation and image documentation and report;

 36902

with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiologic supervision and interpretation necessary to perform the angioplasty

 36903

with transcatheter placement of intravascular stent(s), peripheral dialysis segment, including all imaging and radiologic supervision and interpretation necessary to perform the stenting, and all angioplasty within the peripheral dialysis segment

When to use 36904, 36905 and 36906

The physician treats the dialysis circuit occlusion with mechanical thrombectomy and/or thrombolysis infusion. The devices used for mechanical thrombectomy include those that fragment the thrombus with or without removal of the clot, as well as those that come into contact with the vessel wall. The dialysis circuit is cannulated to gain access and 5,000 units of heparin are administered. Angiography is performed to confirm the occluded segment. A hydrophilic wire is passed across the occlusion, followed by passing of the Trellis device over a stiff exchange length wire. The distal and proximal balloons are inflated in the segment on either side of a treatment zone containing infusion to isolate the treatment zone and to sustain the fluid concentration that is infused.

One milligram of tissue plasminogen activator (TPA) is infused into the treatment zone. The Turbo Trellis is run at 4,000 rpm for five minutes. After the proximal balloon is deflated, small clots are removed via the integral aspiration port to prevent embolization. Thrombolysis infusion may be performed with a catheter threaded over the wire for pharmaceutical administration directly within the thrombosis. When the procedure is complete, the instruments are removed and pressure is applied over the puncture site to stop the bleeding. This procedure is reported with CPT code 36904 and includes imaging guidance, diagnostic angiography, catheter placement, and intraprocedural pharmacological thrombolytic injections.

CPT code 36905 is reported  when the peripheral dialysis segment is treated with balloon angioplasty. A catheter with a balloon attached is inserted into the segment and fed into the narrowed portion, where its balloon may be inflated several times in order to stretch the diameter allowing a more normal flow of blood through the area.

CPT code 36906 is reported when the peripheral dialysis segment is treated with an intravascular stent. A catheter with a stent-transporting tip is threaded over the guidewire into the vessel and the wire is extracted. The catheter travels to the point where the vessel needs additional support. The compressed stent is passed from the catheter into the vessel, where it deploys, expanding to support the vessel walls. Once the procedure is complete, the catheter is removed and pressure is applied over the puncture site.

36904

Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiologic supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural pharmacologic thrombolytic injection(s);

 36905

with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiologic supervision and interpretation necessary to perform the angioplasty

 36906

with transcatheter placement of intravascular stent(s), peripheral dialysis segment, including all imaging and radiologic supervision and interpretation necessary to perform the stenting, and all angioplasty within the peripheral dialysis circuit

 +36907

Transluminal balloon angioplasty, central dialysis segment, performed through dialysis circuit, including all imaging and radiologic supervision and interpretation required to perform the angioplasty (list separately in addition to code for primary procedure)

 + 36908

Transcatheter placement of intravascular stent(s), central dialysis segment, performed through dialysis circuit, including all imaging radiologic supervision and interpretation required to perform the stenting, and all angioplasty in the central dialysis segment (list separately in addition to code for primary procedure)

 + 36909

Dialysis circuit permanent vascular embolization or occlusion (including main circuit or any accessory veins), endovascular, including all imaging and radiologic supervision and interpretation necessary to complete the intervention (list separately in addition to code for primary procedure)

In ICD 10, the amount of codes has increased. Therefore, when we have to code 996.73 in ICD-19m in ICD 10 we have several codes depending on the diagnosis occur in the AV fistula like Embolism, hemorrhage, thrombosis etc. Let check the crosswalk for 996.73 in ICD 10.

T82.818A  Embolism of vascular prosthetic devices, implants and grafts, initial encounter

T82.828A  Fibrosis of vascular prosthetic devices, implants and grafts, initial encounter

T82.838A  Hemorrhage of vascular prosthetic devices, implants and grafts, initial encounter

T82.848A  Pain from vascular prosthetic devices, implants and grafts, initial encounter

T82.858A  Stenosis of vascular prosthetic devices, implants and grafts, initial encounter

T82.868A  Thrombosis of vascular prosthetic devices, implants and grafts, initial encounter

T82.898A  Other specified complication of vascular prosthetic devices, implants and grafts, initial encounter 

Now, I hope you are clear with the procedure performed with CPT code for fistulogram and the ICD codes used with these procedures. Please share if you like the article.