November 17, 2016

Question:
In evaluating an occluded AV graft, I punctured the graft and performed a dialysis circuit venogram, for which I billed 36147. If I had a concern about occlusive disease in the arterial inflow, and performed and documented an arteriogram of the same arm, can I bill a 75710?

Answer:
Great question! Code 36147 includes imaging of the venous outflow (up to and including imaging of the inferior and superior vena cava) and the peri-anastomotic portion of the arterial anastomosis. The peri-anastomotic section includes the short segment of the artery immediately adjacent to anastomosis and the anastomosis itself. If there is documented medical necessity to evaluate the arterial patency in the same extremity not generally considered to be part of the AV graft, that angiogem may be reported with 75710. This will also typically require more selective catheterization into the involved artery. This may be reported with a 36215 for a first order catheterization.

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WEBINAR ALERT!
The codes for AV access/dialysis circuit imaging and interventions all change on January 1, 2017. Join Teri Romano for a webinar on these and other new vascular codes on December 14, 2016. 

*This response is based on the best information available as of 11/17/16.