AHA Coding Clinic® for HCPCS - 2026 Quarter 3; Ask the Editor

Arteriovenous Fistula Revision with Angioplasty

A patient with end stage renal disease (ESRD) and left upper extremity brachiocephalic arteriovenous fistula (AVF) presented for inspection of the fistula due to high venous pressures. After location of the AVF via ultrasound, an incision was made until the fistula was encountered. The outflow vein was directly accessed with a micropuncture needle and a diagnostic fistulogram/venogram was performed which demonstrated greater than 50% stenosis at the cephalic arch with otherwise patent inflow, cannulation segment, and no central venous stenosis. Through the micropuncture sheath balloon angioplasty of the cephalic arch stenosis was performed via catheter-based technique with improved outflow. Following the endovascular intervention, open banding of the AVF was performed using a circumferential suture to reduce the fistula diameter (~5 mm) over a 1.5 cm segment near the anastomosis to treat the high flow. The fistula remained patent with an adequate thrill at completion and the incision was closed. Which CPT code(s) should be reported to capture the peripheral dialysis circuit angiography with angioplasty and the open surgical banding revision? ...

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