dialysis access creation? Help

ttglasscock

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I'm trying to figure out the difference between CPT codes 36821 and 36825. Also, is a PTFE graft creation 36830?

How would this be coded? When I see use as a conduit it makes me think I should use 36825. However, the procedure description says radiocephalic AV fistula.



A longitudinal incision was made over the distal arm 112 way between the radial artery and cephalic vein. SOft tiSsues were sharply divided down to the cephalic vein. All skin bleeders were stopped using the electrocautery. The cephalic vein was dissected proximally and distally. It appeared to be large enough to use as a conduIt for fistula creation. The cephalic vein was ligated in the distal aspect of the operative field using a 2-0 Sflk tie and a clip. We then passed coronary dilators up the cephalic vein using progressively larger size is up to 3 mm to ensure patency. We flushed the cephalic vein using heparinized saline and clamped it USing a non-traumatic clamp. Soft tissues were then sharply divided down to the palpable radIal artery. Any vein branches crossing the artery were ligated usIng silk sutures and the clips. Once the radial artery was completely expose we then began our isolation of the artery. The artery was dissected proximally and distally and encircled with vessel loops. 5000 units of heparin were given and 3 mIn were allowed to elapse. Proxlmal and distal control were gained on the artery and a #11 blade scalpel was used to make an anterior arteriotomy of approximately 1 cm in length. Heparinized saline was instilled in the artery proximal and distal to the area of control. The cephalic vein was then beveled using coronary Potts scissors into a triangular hood. 6-0 Prolene sutures were then placed midway the arteriotomy on each side to hold the artery open. Using 6 0 Prolene on a BV 1 needle, and end-to-side anastomosis was performed between the cephalic vein and artery. Just prior to the completion of the anastomosis, distal control on the artery was temporarily released to observed the appropriate backbleeding. Control was released on the cephalic vein to observe its back bleeding. All dot was removed from the arterial bed using heparinized saline. The anastomosis was completed. Control was released on the radial
artery and the cephalic vein. There was a thrill In the cephalic vein and there was a pulse In the radial artery proximal and distal to the anastomOSiS. Hemostasis was obtained. The signals were checked in the wrist to ensure that the patient retained the preoperative assessment. The heparin was reversed with protamine. The wounds were thoroughly irrigated with normal saline. The wounds were closed In 2 layers of 2-0 Vicryl for the deep tissue layers carefully making sure to dose the dead space and to not entrap any nerves.
The skin was dosed using 4-0 Monocryl in a running Fashion. Topical sealant was placed on the incision. Any blood on the arm was carefully cleaned away and sterile dressfngs were placed on the wounds. We did a final check to ensure that the thrill In the Vein remained and the patient retained the preoperative signals at the wrist. The hand remained warm and had good capillary refill. The patient was awakened from anesthesia and taken to the recovery room. There were no complications.
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such78

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Baldwin Park, CA
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I'm trying to figure out the difference between CPT codes 36821 and 36825. Also, is a PTFE graft creation 36830?

How would this be coded? When I see use as a conduit it makes me think I should use 36825. However, the procedure description says radiocephalic AV fistula.



A longitudinal incision was made over the distal arm 112 way between the radial artery and cephalic vein. SOft tiSsues were sharply divided down to the cephalic vein. All skin bleeders were stopped using the electrocautery. The cephalic vein was dissected proximally and distally. It appeared to be large enough to use as a conduIt for fistula creation. The cephalic vein was ligated in the distal aspect of the operative field using a 2-0 Sflk tie and a clip. We then passed coronary dilators up the cephalic vein using progressively larger size is up to 3 mm to ensure patency. We flushed the cephalic vein using heparinized saline and clamped it USing a non-traumatic clamp. Soft tissues were then sharply divided down to the palpable radIal artery. Any vein branches crossing the artery were ligated usIng silk sutures and the clips. Once the radial artery was completely expose we then began our isolation of the artery. The artery was dissected proximally and distally and encircled with vessel loops. 5000 units of heparin were given and 3 mIn were allowed to elapse. Proxlmal and distal control were gained on the artery and a #11 blade scalpel was used to make an anterior arteriotomy of approximately 1 cm in length. Heparinized saline was instilled in the artery proximal and distal to the area of control. The cephalic vein was then beveled using coronary Potts scissors into a triangular hood. 6-0 Prolene sutures were then placed midway the arteriotomy on each side to hold the artery open. Using 6 0 Prolene on a BV 1 needle, and end-to-side anastomosis was performed between the cephalic vein and artery. Just prior to the completion of the anastomosis, distal control on the artery was temporarily released to observed the appropriate backbleeding. Control was released on the cephalic vein to observe its back bleeding. All dot was removed from the arterial bed using heparinized saline. The anastomosis was completed. Control was released on the radial
artery and the cephalic vein. There was a thrill In the cephalic vein and there was a pulse In the radial artery proximal and distal to the anastomOSiS. Hemostasis was obtained. The signals were checked in the wrist to ensure that the patient retained the preoperative assessment. The heparin was reversed with protamine. The wounds were thoroughly irrigated with normal saline. The wounds were closed In 2 layers of 2-0 Vicryl for the deep tissue layers carefully making sure to dose the dead space and to not entrap any nerves.
The skin was dosed using 4-0 Monocryl in a running Fashion. Topical sealant was placed on the incision. Any blood on the arm was carefully cleaned away and sterile dressfngs were placed on the wounds. We did a final check to ensure that the thrill In the Vein remained and the patient retained the preoperative signals at the wrist. The hand remained warm and had good capillary refill. The patient was awakened from anesthesia and taken to the recovery room. There were no complications.
EBl: less


It sounds like direct creation to me as CPT 36821. The surgeon did not mention any graft (autogenous/nonautogenous) was used in this case. You can also check charge if any graft is charged. Surgeon usually indicates graft is used to connect vein and artery. In that case, you should assign 36825/36830.
 
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