When CPT® 2012 added instructions for diagnostic arteriovenous shunt access code 36147, it shed some light on proper coding of interventions, as well. Here’s what the guidance reveals about vessel segments and choosing between venous and arterial intervention codes.
Intervention Comprehension Starts With Anatomy
To ace coding for arteriovenous (AV) shunt interventions, you must know that “the AV shunt is artificially divided into two vessel segments,” according to CPT® guidelines. This is vital because you count the number of interventions based on the number of segments involved rather than the number of lesions.
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Segment 1: The peripheral segment extends from the peri-arterial (near the artery) anastomosis through the axillary vein. If the shunt has a cephalic venous outflow CPT® includes the entire cephalic vein in the first segment.
In other words, segment 1 includes:
- The shunt itself, whether a fistula or graft
- The opening (anastomosis) of the shunt into the artery
- The venous system starting with the vein connected to the shunt and going through to the axillary vein in the upper chest/shoulder region. (Humans have two axillary veins, one on each side.)
Alternatively, if the shunt involves a connection between an artery and the cephalic vein (creating cephalic venous outflow), then the entire cephalic vein is also part of segment 1. The cephalic vein runs from the lower arm up through to the upper chest/shoulder region where it joins with the axillary vein.
Segment 2: The second segment includes those veins “central to the axillary and cephalic veins, including the subclavian...
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