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arterial and venous in same zone can you code for both?

Ashley Posted Wed 25th of March, 2015 09:49:59 AM

Coding Scenario:
AV dialysis graft:

If I performed angioplasty of arterial anastamosis and put a stent at the venous anastamosis what codes can I include?
Can I include both 37238 and 35475?

Please let me know.

SuperCoder Answered Thu 26th of March, 2015 02:31:19 AM

As the procedures were performed in 2 different vessels (artery and vein), you can use CPT code 35475 and 37238 together. CCI edits do not bundle them.

Ashley Posted Thu 26th of March, 2015 10:02:24 AM

“ In an AV dialysis graft, aren’t the arterial and venous anastamoses considered to be in the same zone? Aren’t we supposed to pick only one highest code per zone?”

SuperCoder Answered Fri 27th of March, 2015 01:14:28 AM

Yes, although their are two separate codes to describe angioplasty at the arterial anastomosis and venous anastomosis, only one of these codes may be assigned per encounter. In that case, you should report CPT code 37238 (Transcatheter placement of an intravascular stent placement including angioplasty, initial vein) only.

Ashley Posted Fri 24th of April, 2015 12:52:22 PM

Ok, so in the first answer we could bill the 35475 and the 37238 because of it being in different vessels but in your second answer you stated only one per encounter but one was in the artery and one in the vein do you have a breakdown of the cut off of zones.

SuperCoder Answered Mon 27th of April, 2015 01:02:55 AM

The 2nd answer is the most correct, i got it after read few more articles on your question. Please use 37238 only.

Ashley Posted Fri 01st of May, 2015 13:50:09 PM

What was the cut off not allowing us to bill for both the 37238 and the angioplasty 37475

SuperCoder Answered Mon 04th of May, 2015 01:11:03 AM

Please see the below mentioned coding scenerios:
Here are some common coding scenarios:

Scenario 1: Stent placement with or without PTA at arterial anastomosis

37236 (arterial stent)
Scenario 2: Stent placement with or without PTA at venous anastomosis

37238 (venous stent)
Scenario 3: Stent placement at both the arterial (37236) and venous anastomosis (37238) with or without PTA

37238 only. NCCI edits state that code 37236 is bundled with code 37238.
Scenario 4: Stent placement at arterial anastomosis (37236) with PTA at venous anastomosis (35476/75978)

37236 only. PTA is bundled with stent when performed in the same vessel.
Scenario 5: Stent placement at venous anastomosis (37238) with PTA at arterial anastomosis (35475/75962)

37238 only. PTA is bundled with stent when performed in the same vessel.

Ashley Posted Tue 05th of May, 2015 07:51:36 AM

thanks

SuperCoder Answered Wed 06th of May, 2015 00:42:08 AM

Your Welcome.

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