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Dialysis shuntogram

Paula Posted Thu 21st of March, 2013 15:44:51 PM

I have a case where the radiologist punctured the RT forearm fistula and performed imaging of the upper arm, exillary, subclavian and SVC.
Reported with 36147.
He also did a Right Radial Artery puncture and radial artery arteriogram was done under ultrasound guidance.
There is no documentation of a permanent image for the US guide so I'm not billing for that, but do I code 36140 for the Radial puncture? And is the imaging of the Rt radial artery included in the imaging that is in 36147 or is it billed separately?
Thank you,


SuperCoder Answered Wed 27th of March, 2013 17:06:34 PM

Even assuming the right radial artery is the inflow vessel, the separate puncture and imaging should be separately reportable, assuming proper documentation. CPT guidelines state: “The arterial inflow to the AV access is considered a separate vessel. If a more proximal inflow problem separate from the peri-anastomotic segment is suspected and additional catheter work and imaging must be done for adequate evaluation, this work is not included in 36147.” Look at 36140-59, 75710-26.

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