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Q&A: Procedure coding for an aneurysm at arteriovenous fistula

JustCoding News: Inpatient, January 4, 2012

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QUESTION: A patient had an aneurysm at arteriovenous (AV) fistula, and the physician excluded the aneurysm between two clamps, ends oversewn, and excised the aneurysm. The physician used a tunneler to tunnel an 8 mm Flixine graft from the arterial to the venous side, and two end-to-side anastomoses were then performed at the vein and arterial end.

Should we report code 39.42 (revision of AV shunt for renal dialysis) with code 38.63 (other excision of vessel), or code 38.43 (resection of vessel with replacement), or another code(s)?

ANSWER: ICD-9-CM procedure code series 38.6x excludes excision with graft replacement, which the physician performed in this case, so ICD-9-CM procedure code 38.63 is inappropriate.

Procedure code series 38.4x is intended for resection and replacement or bypass of a single vessel—either a single artery or a single vein somewhere in its course in the body—not for an AV graft situation, which involves one artery and one vein.

I believe that ICD-9-CM procedure code 39.42 alone is the proper code to use for this case as it is technically a revision of a dialysis shunt because it includes removal of the old shunt and replacement with a new shunt.

Consider Coding Clinic, fourth quarter, 1993, p. 33, which addresses AV shunt revision with a thrombectomy:

QUESTION: What is the correct ICD-9-CM procedural code for removal of a thrombosis during the revision of an AV shunt? The patient had a recurrent thrombosis of a dialysis graft. Would both 39.49 (other revision of vascular procedure) and 39.42 (revision of AV shunt for renal dialysis) be needed?

ANSWER: No, assign only code 39.42 (revision of AV shunt for renal dialysis) since the thrombosis was removed as part of the revision of the graft.

For this case described above, the complication was the venous aneurysm, whose repair would be included in procedure code 39.42.

Editor’s note: Robert S. Gold, MD, CEO of DCBA, Inc. in Atlanta answered this question. E-mail questions to dcbainc@cs.com.

This answer was provided based on limited information submitted to JustCoding. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.

Need expert coding advice? Submit your question to Managing Editor Doreen Bentley, CPC-A, and we’ll do our best to get an answer for you.

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