Venous Stenosis Associated withTunneled Dialysis Catheter Placement and Exchange

ASDIN Coding University

1

Stenosis With Catheter Placement

• In some cases, stenosis is suspected after the target vein has been cannulated when difficult is encountered in passing a guidewire

• The lesion can be confirmed by angiography

• In some of these cases it is possible to salvage the site by doing a venous angioplasty

2

Coding of Procedure

• This procedure should be coded as a venous angioplasty

• The code for venous angioplasty is 35476 • The descriptor for this code is – transluminal

balloon angioplasty, venous• Code 75978 should also be used for the

radiological supervision and interpretation

3

Angiogram

• In performing this procedure, it may be necessary to do one or several angiograms

• These should not be coded because +77001 (fluoroscopic guidance) that is used for catheter placement bundles all fluoroscopic examinations

4

Use of +77001 - 59

• When a diagnostic S&I code is used in association with a therapeutic S&I code, a -59 modifier should be attached to the former

• If a venous angioplasty is performed in conjunction with a tunneled catheter placement, the diagnostic code +77001 (fluoroscopic guidance) should have a 59 modifier added

5

With Catheter Exchange

• Venous stenosis complicating catheter exchange may be detected in 2 ways– When difficult is encountered inserting the new

catheter– In the process of treating a fibrin sheath

• In both instances, it is not practical to perform an angiogram to document stenosis

• Stenosis is documented by a defect in balloon

6

Difficulty Inserting New Catheter

• When difficult is encountered in inserting the new catheter, is frequently due to stenosis

• In most instances an angioplasty balloon is inserted, passed to the spot and a dilatation is performed

• The presence of stenosis is documented by the defect in the balloon

7

Coding

• This cases should be coded with 35476/75978• The appearance of the balloon should be used

to judge % stenosis compared to what the normal vein should be

• It should be 50% or greater to warrant the code

8

While Treating a Fibrin Sheath

• When a catheter exchange is being done for dysfunction, the case should be checked for a fibrin sheath

• If present, removal is indicated

• This is frequently done with an angioplasty balloon

• In some instances, a defect in the balloon is observed indicating the presence of a stenosis

9

Coding

• This cases should also be coded with 35476/75978

• The appearance of the balloon should be used to judge % stenosis compared to what the normal vein should be

• It should be 50% or greater to warrant the code

10

Fibrin Sheath

• In such a case the fibrin sheath will be removed incidental to the procedure

• This being the case, it should not be coded• The documentation of the case should be

based upon the treatment of the venous stenosis and should state that the fibrin sheath was removed incidentally

11

Fibrin Sheath Coding

• If no stenosis is detected (no defect in balloon), removal of a fibrin sheath should be coded as 36595, mechanical removal of pericatheter obstructive material, from a separate location

• Since the descriptor for this code specifies that it is done from a separate location and in a case such as this it was not , a 52 modifier should be attached

• The S&I code - 75901 should also be used

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Important Note• This document is for informational purposes only and

should serve as a guideline for appropriate coding.• The ultimate responsibility for correct coding

/documentation remains with the provider of service. • ASDIN makes no representation, warranty, or

guarantee that this compilation of information is error-free, nor that the use of this guide will prevent differences of opinion or disputes with CMS or any other carrier.

• ASDIN will bear no responsibility or liability for the results or consequences that may grow out of the use of this guidance.