Tuesday, June 1, 2021

Arteriovenous Fistulas/Grafts

In the kNOW” this month is going to review arteriovenous (AV) fistulas and grafts.  We’ll discuss the similarities and differences and how ICD-10-CM and PCS code assignment is impacted by their differences. 

To begin, we need to understand what AV fistulas and AV grafts are.  The two are similar in that they create a new pathway for blood flow between an artery and a vein and are often performed when a patient has end-stage renal disease (ESRD) and is in need of dialysis.  When an AV fistula is created a direct anastomosis occurs between the artery and vein as illustrated in the picture below. 

Source:  https://www.healthgrades.com/right-care/dialysis/arteriovenous-av-fistula-surgery 

This is different than the creation of an AV graft which requires the use of some type of conduit, such as autologous or synthetic material, to make the connection between the artery and vein as shown below.

Source: https://www.azuravascularcare.com/medical-services/dialysis-access-management/av-graft-placement/

When a complication of an AV fistula arises, it might be challenging to know what ICD-10-CM code to assign.  Third quarter 2020 Coding Clinic provides guidance by verifying that a code from category T82, Complications of cardiac and vascular prosthetic devices, implants, and grafts should be assigned for AV fistula complications.  
Now let’s clarify how to code an AV pseudoaneurysm which may result from repeated punctures of a fistula or graft.  In order to accurately assign an ICD-10-CM code for this condition, the coding professional must know if the pseudoaneurysm is of an AV fistula or graft.  For pseudoaneurysm of an AV fistula the appropriate code is T82.510A for Breakdown (mechanical) of surgically created arteriovenous fistula, initial encounter.  If, however, the pseudoaneurysm is of an AV graft, the proper code assignment is T82.511A, Breakdown (mechanical) of surgically created arteriovenous shunt, initial encounter. 

Source: https://www.researchgate.net/figure/AV-fistula-aneurysm-repair-a-the-aneurysm-as-was-typically-found-at-the-fistula-site-b_fig1_49603755

Note that in both circumstances described above, if there is bleeding documented, the coding will change to T82.838A for Hemorrhage due to vascular prosthetic devices, implants, and grafts, initial encounter for both the AV fistula and the AV graft.
When coding thrombectomies that occur for a clot in a brachiocephalic AV fistula, what body part value is correct?  The important consideration is that an AV fistula is not a device.  Remember, that an AV fistula is created with direct anastomosis between vessels.  Therefore, code for Extirpation from both the brachial artery and the cephalic vein. 

Now you are In the kNOW!!



About the Author 

Dianna Foley, RHIA, CHPS, CCS  is OHIMA's Coding Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.