Do we need code for unilateral extremity arteriography(75710) and catheter code(36140) along with the fistulogram codes in the below procedure?
After obtaining informed consent, the patient's right arm was prepped and
draped in a sterile fashion. Using ultrasound guidance, a right brachia
artery was punctured and a 3 French catheter was placed in the brachial
artery. Angiogram of the brachial artery was performed. The angiogram
revealed the patient's distal brachial artery with proximal radial and
ulnar arteries to be patent.
There is an AV fistula arising from the distal brachial artery. There is
severe anastomotic stenosis and another area of stenosis in the proximal
outflow vein.
The patient's AV fistula was punctured in a retrograde fashion and a 6
French sheath was placed over the wire. An 018 wire was needed to cross
the area of stenosis. Over the wire, a 5 mm balloon was used to perform
angioplasty of the anastomosis and the proximal lateral vein.
Post-angioplasty with a 5 mm balloon, a 6 mm balloon was used to
performed angioplasty of the anastomosis and proximal outflow vein.
After the 6 mm angioplasty, there is marked improvement noted in the
anastomosis, however, the proximal outflow vein is still stenotic.
This was the angioplastied with an 8 mm balloon. Post-procedure,
excellent flow is seen through the AV fistula.
IMPRESSION:
Severe stenosis of the AV fistula and anastomosis and proximal outflow
vein. This is successful treatment with angioplasty. The anastomosis was
treated with a 6 mm balloon and the outflow vein was treated with an
8 mm balloon.
After obtaining informed consent, the patient's right arm was prepped and
draped in a sterile fashion. Using ultrasound guidance, a right brachia
artery was punctured and a 3 French catheter was placed in the brachial
artery. Angiogram of the brachial artery was performed. The angiogram
revealed the patient's distal brachial artery with proximal radial and
ulnar arteries to be patent.
There is an AV fistula arising from the distal brachial artery. There is
severe anastomotic stenosis and another area of stenosis in the proximal
outflow vein.
The patient's AV fistula was punctured in a retrograde fashion and a 6
French sheath was placed over the wire. An 018 wire was needed to cross
the area of stenosis. Over the wire, a 5 mm balloon was used to perform
angioplasty of the anastomosis and the proximal lateral vein.
Post-angioplasty with a 5 mm balloon, a 6 mm balloon was used to
performed angioplasty of the anastomosis and proximal outflow vein.
After the 6 mm angioplasty, there is marked improvement noted in the
anastomosis, however, the proximal outflow vein is still stenotic.
This was the angioplastied with an 8 mm balloon. Post-procedure,
excellent flow is seen through the AV fistula.
IMPRESSION:
Severe stenosis of the AV fistula and anastomosis and proximal outflow
vein. This is successful treatment with angioplasty. The anastomosis was
treated with a 6 mm balloon and the outflow vein was treated with an
8 mm balloon.