CCO Admin asked:
My coding: 37252; 36907; 76937. Does this sound correct? My doctor seems to
confuse me when he does the dialysis circuit intervention.
The patient was taken to the OR and underwent sedation. Once adequately sedated the patient was prepped and draped in the usual manner and a timeout was performed confirming the procedure and the laterality as well as perioperative abx. We used an US to identify the L CFV and instilled local and used a micropuncture needle to gain access and placed a wire in the lumen; we exchanged the needle for the dilator using modified seldinger technique. The position was confirmed with flouroscopy and we then removed the inner wire and cannula and placed a wire into the lumen and exchanged for a 5 FR sheath. We used a stiff glide wire to access the SVC and attempted to cross into the left subclavian vein but we kept getting kicked into the L IJ. We exchanged our 5 fr sheath for a 6 x 90 sheath into the distal left brachiocephalic vein. We were unable to cross from this anlgle and we used the micropuncture and US to gain access to the LUE AVG as previously described but kept the dilator in place
to peform angiogram and place a wire. We performed a shuntogram with the above findings. We then used a Toui Bourst valve to control the bleeding from the dilator and used a glide wire to attempt to cross the lesion without success. We then used the V18 and a CXI 0.018 and we were able to navigate across the lesion from the LUE. We then used a goose neck snare to capture the wire in the IVC; after backing our sheath down; and we used the body floss technique to advance our sheath with dilator past the lesion. We then placed the IVUS catheter into the L axillary vein and imaged the lesion with the above findings; after backing our sheath into the SVC. We then used a 8 x 60 balloon and on imaging noted residual collaterals as well as stenosis. We then used a 10 x 40 balloon with noted improvement of flow; and loss of collateral veins. We noted good outflow at this point and we were happy. We backed out our wires and catheters and removed our sheaths and dilator and held manual pressure
for 15 minutes until hemostatic.
Answer:
37252 is Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention; including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure).
The 36907 is Transluminal balloon angioplasty; central dialysis segment; performed through dialysis circuit; including all imaging and radiological supervision and interpretation required to perform the angioplasty (List separately in addition to code for primary procedure).36907 is an Add-on code and requires a Primary code.
* Applicable Primary code(s): 36818-36833; 36901; 36902; 36903; 36904; 36905; 36906
The 76937 is Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites; documentation of selected vessel patency; concurrent realtime ultrasound visualization of vascular needle entry; with permanent recording and reporting (List separately in addition to code for primary procedure).76937 is an Add-on code and requires a Primary code.
* Applicable Primary code(s): Contractor Defined.
* If you have listed a code that your Contractor has defined as an applicable Primary Code; you may ignore this warning.
My coding: 37252; 36907; 76937. Does this sound correct? My doctor seems to
confuse me when he does the dialysis circuit intervention.
The patient was taken to the OR and underwent sedation. Once adequately sedated the patient was prepped and draped in the usual manner and a timeout was performed confirming the procedure and the laterality as well as perioperative abx. We used an US to identify the L CFV and instilled local and used a micropuncture needle to gain access and placed a wire in the lumen; we exchanged the needle for the dilator using modified seldinger technique. The position was confirmed with flouroscopy and we then removed the inner wire and cannula and placed a wire into the lumen and exchanged for a 5 FR sheath. We used a stiff glide wire to access the SVC and attempted to cross into the left subclavian vein but we kept getting kicked into the L IJ. We exchanged our 5 fr sheath for a 6 x 90 sheath into the distal left brachiocephalic vein. We were unable to cross from this anlgle and we used the micropuncture and US to gain access to the LUE AVG as previously described but kept the dilator in place
to peform angiogram and place a wire. We performed a shuntogram with the above findings. We then used a Toui Bourst valve to control the bleeding from the dilator and used a glide wire to attempt to cross the lesion without success. We then used the V18 and a CXI 0.018 and we were able to navigate across the lesion from the LUE. We then used a goose neck snare to capture the wire in the IVC; after backing our sheath down; and we used the body floss technique to advance our sheath with dilator past the lesion. We then placed the IVUS catheter into the L axillary vein and imaged the lesion with the above findings; after backing our sheath into the SVC. We then used a 8 x 60 balloon and on imaging noted residual collaterals as well as stenosis. We then used a 10 x 40 balloon with noted improvement of flow; and loss of collateral veins. We noted good outflow at this point and we were happy. We backed out our wires and catheters and removed our sheaths and dilator and held manual pressure
for 15 minutes until hemostatic.
Answer:
37252 is Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention; including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure).
The 36907 is Transluminal balloon angioplasty; central dialysis segment; performed through dialysis circuit; including all imaging and radiological supervision and interpretation required to perform the angioplasty (List separately in addition to code for primary procedure).36907 is an Add-on code and requires a Primary code.
* Applicable Primary code(s): 36818-36833; 36901; 36902; 36903; 36904; 36905; 36906
The 76937 is Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites; documentation of selected vessel patency; concurrent realtime ultrasound visualization of vascular needle entry; with permanent recording and reporting (List separately in addition to code for primary procedure).76937 is an Add-on code and requires a Primary code.
* Applicable Primary code(s): Contractor Defined.
* If you have listed a code that your Contractor has defined as an applicable Primary Code; you may ignore this warning.
Last edited: