AV shunt intervention

August 21, 2010

Question:

Dr. Z; I have reviewed your book for the Av fistulogram and interventions. I would like to know if my coding is correct given this episode of care on this pt. My codes are 36120, 75790, 35476, 36147, 36148, 75978, 35476-59, 75978-59. I have the use of three catheters and three puncture sites. Under ultrasound guidance access was gained into the left brachial artery, guidewire was introduced and the needle removed. Through this 5 french dilator, a left upper ext atrteriogram, fistulogram and venogram preformed. Images reveal patency of left axillary & brachial arteries with patency of proximal radial, ulnar and interosseous arteries. An Av fistula is seen arising from the distal portion of the brachial artery at approx. the level of the elbow joint to a drainign cephalic vein. The remainder of the cephalic vein is seen to be patent. The left axillary and proximal left subclavin veins are seen to be patent however, thereis a short segmental occlusion of the mid subclavin vein at the entry of a pacemaker wire. Thid distal portion of the subclavian is patent and there is patency of the innominate vein and the superior vena cava. Under ultrasound guidance access was gained into the draining cephalic vein with the needle directed towards the arterial anastomosis. A stiff guidwire introduced and a 6 french sheath was advanced. The stenotic segment of the draining cephalic vein was traversed. Mutiple angioplasties of these segments of he proximal draining cephalic vein preformed. Repeat fistulogram reveals significant improvement in the degree of stenosis with some minimal residula stenosis. Acess was also gained into the drainign cephalic vein with needle towards the central venous circulation. A sheatlh dilator system was advanced, serial dilatiations were preformed at the entry site. Utilizing a guidwire and cath combination, the occluded segment of the subclavin vein was successfully traversed, mutliple angioplasties of the segment were performed utilizing balloon angioplasty catheters. Repeat venogram completely callous aeration of the subclavian vein with no residual areas of stenosis. All 3 catheters were removed>>>>>>>>>>

Question ID: 2266
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