Fistulogram coding guidelines are little difficult in interventional radiology. The CPT code for fistulogram is few but has to be used carefully. The CPT code 36147 and 36148 (both codes have been deleted from 2017) are to be used only depending on the documentation. As like other procedure for chest tube placement coding or breast biopsy coding these procedures are quite easy to understand. Now these codes will include most of the small procedures, which will help in coding a single CPT code. Previously we have learnt in coding for ultrasound guided thyroid biopsy, placement of urethral catheter and joint arthrocentesis coding which require either guidance or Supervision and interpretation code. But, CPT code 36147 includes all the guidance and S&I codes performed in this procedure. Now, we will slowly learn about the add-on 36148 CPT code as well. Below links will give all knowledge about the new AV fistula coding.

New CPT code for Fistula access 36901

New Fistulogram CPT interventional codes coding guide 

image courtesy: http://www.niddk.nih.gov

When to code CPT code 36147 and 36148

Understanding and using the fistulogram codes will be very useful from each and every aspect. Whether you want to become a Professional medical coder and prepare and clear the Coding Certification exams by AAPC or you want to learn and grow in medical coding career. As, you code and get more experience, you become more and more perfect in medical coding. Now, let checkout the code description for these CPT codes

36147– Introduction of needle and/or catheter, arteriovenous shunt created for dialysis (graft/fistula); initial access with complete radiological evaluation of dialysis access, including fluoroscopy, image documentation and report (includes access of shunt, injection[s] of contrast, and all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava)

+36148-Introduction of needle and/or catheter, arteriovenous shunt created for dialysis (graft/fistula); additional access for therapeutic intervention (list separately in addition to code for primary procedure).

If you see above, CPT code 36148 is an add-on code. Hence, the code 36148 should always be used with CPT code 36147. But these procedures are not simple as selective and non-selective catheterization of lower extremity or coding ABI index CPT code 93923. These are as tricky as our new modifiers for 59 in 2015. Let us check how and when we should use them while coding medical charts.

Documentation required for CPT code 36147 and 36148

The CPT code 36147 is used for coding the initial access of needle or catheter in the fistula or graft. The CPT code 36147 includes everything from access, evaluation, guidance and imaging. If the procedure requires another or additional access and the documentation supports we can use 36148 code only in one condition. CPT code 36148 should be coded only when any intervention procedure like angioplasty, stent, artherectomy etc is done in fistula with the additional access. Hence, do check the report properly before using this add-on code. If you have nice experience of coding sample interventional radiology chart you can learn how to use these CPT codes.

If you facing any difficulty with these Codes, you can learn initially the basic coding of radiology procedure like coding ultrasound renal exam, ultrasound abdominal procedure, Modified barium swallow exam coding, Bone density scan DEXA coding, coding peripheral angiography procedure etc.  Once, you are good in diagnostic radiology you can go ahead and learn interventional radiology coding.