AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS - 2020 Issue 3; Ask the Editor
Thrombectomy of Arteriovenous Fistula with Angioplasty and Stent Placement
A patient presents for treatment of an ulcerated bleeding brachiocephalic arteriovenous (AV) fistula. At surgery, stenosis of previously placed innominate vein stent and cephalic arch stenosis were discovered. A balloon was inflated within the stent and angioplasty was performed on the innominate vein stent as well as the cephalic arch. Following angioplasty, a clot formed within the fistula. Open thrombectomies of the AV fistula were performed. Repeat fistulogram revealed inadequate flow through the innominate vein stent. A stent graft was then positioned, overlapping the previously placed innominate vein stent and extending up into the cephalic arch. Following placement of the stent graft, excellent flow was achieved through the central veins into the right atrium and completely resolved the cephalic arch stenosis. What is the correct root operation for the placement of the stent graft within the innominate vein stent, Revision or Dilation? How is the body part value determined for the thrombectomy portion of the procedure? Surgeons rarely identify vein or an artery. Additionally, since an AV fistula is a direct anastomosis, is it considered a device in ICD-10-PCS terms? ...
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Article Overview
This premium article reviews a complex vascular access procedure involving an arteriovenous fistula, venous stent treatment, thrombectomy, and stent graft placement. It is intended for coders and other revenue cycle professionals who need to understand how the case is analyzed in an ICD-10-PCS setting, including how procedure classification questions are approached for the central venous and fistula components.
Why This Topic Matters
Dialysis access procedures often involve multiple intertwined interventions and anatomy-specific coding decisions. Understanding how the case is organized helps coders evaluate procedure assignments for vascular access cases without relying on assumptions.
What You Will Learn
- How this type of dialysis access case is framed for coding analysis
- How angioplasty, thrombectomy, and stent graft placement are considered in a complex vascular access encounter
- How procedure classification questions arise for fistula and central venous structures
- How anatomy and operative context affect ICD-10-PCS review of vascular interventions
Who Should Read This
- Inpatient coders
- Coding auditors
- Clinical documentation integrity specialists
- Revenue cycle professionals
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