36902 is fistula/PTA, you code that along with 36581? I don't ever code those two together?

When doing a fibrin sheath angioplasty on a catheter exchange I code 36902 along with 36581. How do others code for this?

36902 is specific to fistulagram with angioplasty of the peripheral AV access.

When doing a fibrin sheath disruption, the most appropriate code would be 36595 unless you could demonstrate that there was not only a fibrin sheath but also a central venous stenosis, in which case the appropriate code would be 37248 (central venous angioplasty from a non-dialysis access circuit).

Of note -- if you were doing a fistulagram and only found a flow limiting central venous stenosis that required intervention, the 36902 code would not be appropriate as that code is specific for an angiogram with angioplasty of the peripheral segment of the dialysis access. In this case -- you would code 36901 (angiogram of the dialysis access circuit) and the add-on code, 36907 (angioplasty of the central segment of the dialysis circuit/central veins since the approach is from the dialysis circuit).

Although this is the correct coding, please keep in mind, the new add-on codes (36907-36909) are only fully reimbursable in the extension of practice setting and not reimbursable in the ASC setting (other than the professional component)

Hope that helps

Correct, that's basically how I code it. In fact for cath exchange if you are coding 36902 I don't think you would be getting reimbursed for that?

I do not routinely code 36595 on an exchange but will do 37248 with a distinct stenosis.

Most helpful. Thanks! I will make the corrections in billing

Check out catheter case 8; page 110 of the 2018 ASDIN/RPA Coding Manual