Radiology Question for the Week of January 18, 2016

Question:

When x-raying a lower extremity arteriovenous (AV) graft, the physician performs an arterial anastamosis angioplasty and an external iliac vein angioplasty. There was no venous anastamosis stenosis. Would the external iliac vein be considered a “central” or “peripheral” vein in the lower extremities? What veins constitute “central” and “peripheral” veins in the lower extremities?

Answer:

For lower extremity grafts, the peripheral segment venous outflow is from the anastomosis through the common femoral (to the level of the inguinal ligament). Iliac veins and inferior vena cava (IVC) are considered central. 

The arterial anastomosis angioplasty would be assigned code 37224 (revascularization, endovascular, open or percutaneous, femoral, popliteal artery[s], unilateral; with transluminal angioplasty). Since this code includes access/catheterization, you would not report 36147 for the fistulogram but would instead report code 75791.

75791Angiography, arteriovenous shunt (e.g., dialysis patient fistula/graft), complete evaluation of dialysis access, including fluoroscopy, image documentation and report (includes injections of contrast and all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava), radiological supervision and interpretation

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