CULINTZ
Networker
Does anyone have a recommendation on how to code the following scenario for the attempt to create an AV fistula that was aborted due to the size of the patient's veins and artery? This is for the hospital bill.
The physician documented it in the op note as a left arm exploration. Thanks in advance.
An incision was made in the left axilla, dissection was carried down to the left axillary vein, it was quite small and was not of adequate size to support an AV graft. The ultrasound was then used to visualize the cephalic vein, it looked somewhat small and sclerotic in the antecubital fossa, but it appeared to increase in size along the upper arm. An incision was subsequently made in the antecubital fossa, dissection was carried down to the cephalic vein which was dissected out. Small venous side branches were tied off and ligated using 3-0 silk. The vein was thickened and somewhat sclerotic at the more proximal aspect. The brachial artery was dissected out and encircled with vessel loops. It was soft, but somewhat small in diameter. The patient was systematically heparinized. The cephalic vein was then transected in the proximal aspect. The proximal aspect was oversewn using a 5-0 Prolene. The vein was then attempted to be dilated up using heparinized saline. Unfortunately, the vein did not adequately dilate and I did not feel that it would support an AV fistula. We subsequently used a 2-0 silk to tie off the cephalic vein. Given the size of her veins and the size of her artery, we elected to abort the case.
The physician documented it in the op note as a left arm exploration. Thanks in advance.
An incision was made in the left axilla, dissection was carried down to the left axillary vein, it was quite small and was not of adequate size to support an AV graft. The ultrasound was then used to visualize the cephalic vein, it looked somewhat small and sclerotic in the antecubital fossa, but it appeared to increase in size along the upper arm. An incision was subsequently made in the antecubital fossa, dissection was carried down to the cephalic vein which was dissected out. Small venous side branches were tied off and ligated using 3-0 silk. The vein was thickened and somewhat sclerotic at the more proximal aspect. The brachial artery was dissected out and encircled with vessel loops. It was soft, but somewhat small in diameter. The patient was systematically heparinized. The cephalic vein was then transected in the proximal aspect. The proximal aspect was oversewn using a 5-0 Prolene. The vein was then attempted to be dilated up using heparinized saline. Unfortunately, the vein did not adequately dilate and I did not feel that it would support an AV fistula. We subsequently used a 2-0 silk to tie off the cephalic vein. Given the size of her veins and the size of her artery, we elected to abort the case.