AMA Clinical Examples in Radiology - 2012 Issue 2 (Spring)
AV Fistula Analysis
Arteriovenous Fistula (AVF) Dialysis Graft with Arterial Access Clinical History End-stage renal disease with left upper arm transposed brachiobasilic fistula. Patient presents with swollen left upper extremity for four days. Patient recently discontinued anticoagulation. There is a questionable history of steal symptoms within the left hand during hemodialysis. Procedure Dialysis fistulogram and left upper extremity arteriogram Medications Versed, 2.5 mg IV; Fentanyl, 125 mcg IV Technique Continuous monitoring of intravenous moderate sedation was performed by the radiology nurse. Vital signs throughout the procedure remained stable. Moderate sedation time was 70 minutes. 76937 76937 36147 36215 Access to the...
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Article Overview
This article reviews a dialysis access study involving an upper-extremity arteriovenous fistula, associated arteriography, and venous angioplasty, with emphasis on how the encounter is represented in CPT, HCPCS Level II, and related quality-reporting code references. It is useful for coders, auditors, and radiology or interventional teams who need to compare the clinical narrative with the reported procedural codes and documentation elements.
Why This Topic Matters
Dialysis access studies often involve multiple imaging and interventional components in a single encounter, making accurate code identification and bundling awareness important for compliant reporting and documentation review.
Article Sections
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Clinical History
Summarizes the patient context, access history, and presenting concerns that frame the procedure.
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Procedure
Describes the diagnostic imaging and interventional components performed during the encounter.
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Technique
Outlines procedural monitoring, sedation, access approach, and general technical conduct.
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Findings
Presents the imaging observations related to fistula patency, venous obstruction, arterial circulation, and post-treatment status.
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Impression
Provides the radiologist’s summarized interpretation of the study findings and treatment result.
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How to Code
Explains the coding framework discussed in the article, including imaging, access, catheterization, angioplasty, and quality-reporting references.
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Discussion
Reviews the rationale for the reported codes and the broader coding considerations for dialysis access procedures.
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Coding Tips
Highlights general coding considerations for angioplasty segment selection, reporting distinctions, and modifier use.
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References
Lists the source publications and reference materials cited by the article.
What You Will Learn
- How the article frames dialysis access imaging and intervention in a coding context.
- Which documentation elements are emphasized for reporting vascular access and fluoroscopy-related services.
- How the article organizes discussion of diagnostic, interventional, and quality-reporting topics.
- What general coding issues are highlighted for arteriovenous fistula procedures.
Who Should Read This
- Medical coders
- Coding auditors
- Interventional radiology staff
- Radiology documentation specialists
- Revenue cycle professionals
Codes Discussed
Modifiers Discussed
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