Health Information Management

Tip: Know contractor requirements for coding venoplasty

APCs Insider, September 17, 2010

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Venoplasty, the mechanical widening of a narrowed or obstructed vein, is commonly performed on patients with arteriovenous fistulas. To code for a venoplasty, the physician must document the stenosis. Increasingly, FIs and MACs are releasing local coverage determinations (LCD) with definitions of the percentage of stenosis required for a venoplasty. 

The LCDs also increasingly include specific terms the physician must document, such as a recirculation percentage greater than 10%–15% or development of pseudoaneurysm(s). Make sure you know what your local contractor requires and ensure that those terms and percentages are in the operative report before coding a venoplasty.

You may code only one venoplasty per zone of intervention. There are two zones:

  • The peripheral zone includes the graft and peripheral extremity veins up to and including the axillary vein
  • The central zone includes the subclavian, brachiocephalic, and superior vena cava

For venoplasty in either zone, use codes 35476 and 75978. If the physician performs both a central zone venoplasty and a peripheral zone venoplasty, add modifier -59 (distinct procedural service) to the second set of codes to show that they represent a separate procedure. The central venoplasty must be a separate and distinct procedure to add modifier -59.

This tip was adapted from “Differentiate between dialysis access procedures” in the September issue of Briefings on APCs.

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