Wiki fistula and ligation

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Question is this enough to code for a ligation 37607


the cephalic vein was identified and was skeletonized along its distal 5 cm in the arm, dissection being carried as distally as possible. The tendonous aponeurosis of the biceps was then incised and the brachial artery was exposed and was encircled with a vessel loop. The patient was given heparin intravenously.

The cephalic vein was ligated at its most distal end and was brought into the arterial side of the operative field. Vascular clamps were used to obtain control of the brachial artery and a 6 mm longitudinal arteriotomy was then made with a 11 blade. Stay sutures were placed. The end of the vein was slightly spatulated to match the size of the arteriotomy. The arterio-venous anastomosis was then performed with 6-0 prolene, in a continuous running manner. At the completion the artery was back and forward flushed., and the sutures were tied.
 
No, 37607 is for the ligation of an existing fistula. This report sounds like the provider is creating a fistula, in which case the ligation of the vein is incidental. I believe the correct code here should be 36821, though I'm not sure we're looking at the complete report?
 
Thanks so much
this was created with a vessel loop and not direct would this be 36825??? not 36821??
thanks for the input i love it
 
You're welcome.

This is direct - the surgeon has incised the brachial artery and sutured end of the cephalic vein directly to the opening in the artery. 36825 would be for a fistula created using a vessel that was harvested from another site and grafted into the vessels at the fistula location.
 
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