EmailFistulogram and angioplasty
Publication Date: September 2007
Implementation Date: 1/07/2020
Updated Date: 27/07/2021
ICD 10 AM Edition: Fifth edition
Query Number: 2324
Can you please advise the code selection for procedures Fistulogram and angioplasty. Please refer to the following report.
FISTULOGRAM AND ANGIOPLASTY - (RA)
CLINICAL NOTES
Right radiocephalic fistula. Swollen right arm. Previous stenting distal subclavian vein.
FINDINGS
The fistula was punctured at the upstream dialysis puncture site under local anaesthesia with an 18-gauge angio catheter. Run off venography was performed. This confirmed proximal to mid stent stenosis on a background of stent fracturing in the distal right subclavian vein.
A 5-french sheath was inserted over a guidewire. The occlusion in the stent was passed with a stiff guidewire and the aid of a van Schie 1 catheter. The stent was angioplastied with a 40 X 9mm diameter balloon. Following angioplasty good flow was seen through the re-opened distal right subclavian vein with a residual stenosis of less than 50% in the mid-reaches of the fractured stent. A pressure dressing was applied on removal of the sheath at the end of the procedure to control bleeding.
CONCLUSION
Fracturing and instant occlusion distal left subclavian vein. Good result following angioplasty with less than 50% residual stenosis.
We have coded 35303-06 [754] Percutaneous transluminal balloon angioplasty as principal procedure. Do we code Fistulogram 59739-03 [1988] and/or Diagnostic DSA as the additional procedure?
Also, should we code fistulogram and/or intraoperative angiography as the additional procedure code if the fistulogram is intraoperative (not diagnostic)?
Search Details:
VICC query #2039 Intraoperative computerised tomography
FISTULOGRAM AND ANGIOPLASTY - (RA)
CLINICAL NOTES
Right radiocephalic fistula. Swollen right arm. Previous stenting distal subclavian vein.
FINDINGS
The fistula was punctured at the upstream dialysis puncture site under local anaesthesia with an 18-gauge angio catheter. Run off venography was performed. This confirmed proximal to mid stent stenosis on a background of stent fracturing in the distal right subclavian vein.
A 5-french sheath was inserted over a guidewire. The occlusion in the stent was passed with a stiff guidewire and the aid of a van Schie 1 catheter. The stent was angioplastied with a 40 X 9mm diameter balloon. Following angioplasty good flow was seen through the re-opened distal right subclavian vein with a residual stenosis of less than 50% in the mid-reaches of the fractured stent. A pressure dressing was applied on removal of the sheath at the end of the procedure to control bleeding.
CONCLUSION
Fracturing and instant occlusion distal left subclavian vein. Good result following angioplasty with less than 50% residual stenosis.
We have coded 35303-06 [754] Percutaneous transluminal balloon angioplasty as principal procedure. Do we code Fistulogram 59739-03 [1988] and/or Diagnostic DSA as the additional procedure?
Also, should we code fistulogram and/or intraoperative angiography as the additional procedure code if the fistulogram is intraoperative (not diagnostic)?
Search Details:
VICC query #2039 Intraoperative computerised tomography
Response
This query was originally published in the 2007-08 September Database as follows:
The VICC advises that the correct codes to assign for the case cited are:
59739-03 [1988] Other sinography
for the fistulogram performed whether diagnostic or intraoperative; and
35303-06 [754] Percutaneous transluminal balloon angioplasty
From the information provided, VICC members would not assign a code for the DSA.
This query has been updated for clarity as follows:
The VICC advises that the correct codes to assign for the case cited are:
59739-03 [1988] Other sinography
for the fistulogram performed whether diagnostic or intraoperative; and
35303-06 [754] Percutaneous transluminal balloon angioplasty
From the information provided, VICC members would not assign a code for the DSA.
VICC advises a code for the fistulogram would only be coded if it meets the criteria for coding a per ACS 0042 Procedures not normally coded.
The VICC advises that the correct codes to assign for the case cited are:
59739-03 [1988] Other sinography
for the fistulogram performed whether diagnostic or intraoperative; and
35303-06 [754] Percutaneous transluminal balloon angioplasty
From the information provided, VICC members would not assign a code for the DSA.
This query has been updated for clarity as follows:
The VICC advises that the correct codes to assign for the case cited are:
59739-03 [1988] Other sinography
for the fistulogram performed whether diagnostic or intraoperative; and
35303-06 [754] Percutaneous transluminal balloon angioplasty
From the information provided, VICC members would not assign a code for the DSA.
VICC advises a code for the fistulogram would only be coded if it meets the criteria for coding a per ACS 0042 Procedures not normally coded.
