AHA Coding Clinic® for HCPCS - 2021 Issue 4; Ask the Editor
Revision of an arteriovenous fistula
A dialysis patient with a left wrist arteriovenous (AV) fistula for eight years presented with thrombus in the antecubital vein. Prior to thrombectomy of the antecubital vein, an AV fistula was created in the left upper arm/antecubital fossa. An incision was made in the elbow crease and the brachial artery was dissected. The cephalic vein was measured for adequate length to reach the brachial artery. The thrombosed portion of the antecubital vein was tied off and secured distally. The vein was clamped at the antecubital/cephalic tract as it exited the incision of the upper arm. The vein was then divided. A small frond of thrombus extending into the antecubital vein towards the cephalic tract, which would become the upper arm fistula, was peeled away leaving 80% of the vein without thrombus. The vein was spatulated and prepared for anastomosis. An arteriotomy was made on the brachial artery and the antecubital/cephalic vein was brought into anastomosis with the arteriotomy creating the fistula. Would this be considered a revision to the existing fistula and reported with CPT code 36833, or is the relocation of the fistula from the wrist to the upper arm/antecubital fossa considered creation of a new fistula and reported with CPT code 36821? ...
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