36147 Highlights Official Includes/Excludes Rules in 2012

Watch for 2 distinctly reportable services.

Look through the Surgery section of your 2012 CPT® manual, and you'll see that more than a page of new CPT® 2012 guidelines concerning arteriovenous (AV) shunts. Here are the main points so you can correctly apply the rules to your claims.

Start here: The new guidelines help simplify appropriate reporting for 36147 (Introduction of needle and/or catheter, arteriovenous shunt created for dialysis [graft/fistula]; initial access with complete radiological evaluation of dialysis access, including fluoroscopy, image documentation and report [includes access of shunt, injection(s) of contrast, and all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava]).

The guidelines concerning AV shunts for dialysis present one section for diagnostic studies and one section for interventions. This article will concentrate on the diagnostic study guidelines, which include (1) which services are involved in 36147 and (2) which services you might report in addition to 36147 when carried out.

1. Steer Clear of These Included Services

The guidelines mention that 36147 includes the services described below. You must not report a distinct code for these services.

Access/imaging: The work of directly accessing along with imaging the total AV shunt is included in 36147. According the guidelines, the puncture may be antegrade or retrograde, and then the physician might inject the contrast through a needle or catheter.

Cath manipulation: Catheter advancement in the shunt and/or vena cava is also included. The CPT 2012 guidelines state that 36147 includes all manipulation for diagnostic imaging of the shunt.

Here's what that means for you:

You must not code distinctly for either progressing the catheter to the vena cava or moving forward the catheter via the arterial anastomosis when carried out to visualize the shunt or the anastomosis, which is essentially the surgical connection between the two vessels
Likewise, the CPT 2012 guidelines state that 36147 includes assessing the part of the inflow vessel near the surgical opening. The guidelines denote this as the peri-anastomotic portion of the inflow. Peri- means near or around, so peri-anastomotic implies the portion near or around the surgical connection that exists between the two vessels.

2. Capture These 2 Distinctly Reportable Services

There are services CPT guidelines 2012 maintain you may report along with 36147. These relate to ultrasound guidance as well as arterial inflow selective catheterization.

US guidance: Supposing the documentation is adequate, CPT® 2012 guidelines mention you may report ultrasound guidance meant for puncture of the AV shunt by means of +76937 (Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent realtime ultrasound visualization of vascular needle entry, with permanent recording and reporting [List separately in addition to code for primary procedure]).

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