Good Afternoon! I am reaching out to the IR Coding Community for assistance and potential suggestions asking if the appropriate codes would be applicable for the below indication. Thank you for your suggestions!
36147, 35475, 75962
Procedure:
1. Left upper extremity fistula venous outflow access
2. Left upper extremity arteriovenous fistulogram
3. Cephalic venoplasty
4. Brachiocephalic venoplasty
5. Post venoplasty fistulogram.
6. Monitored conscious sedation.
Medications:
Versed and fentanyl per nursing records was given for conscious sedation.
Lidocaine 1% local.
Procedure details:
After explanation of risks and benefits, an informed consent was obtained. Patient was then positioned supine
on the fluoroscopy table. 1% lidocaine was then infiltrated with and subcutaneous tissues and with ultrasound
guidance, access into the venous out flow tract was obtained with a 21-gauge micropuncture needle. This was used to pass a microwire. The needle was replaced with a microsheath. The inner dilator of the microsheath and microwire were removed. A DSA was then obtained, which demonstrates no significant venous outflow stenosis.
Further centrally however, there is stenosis of the cephalic arch noted as well as mildly of the brachycephalic vein.
A Glidewire was then advanced into the microsheath and into the IVC. A 7 French sheath was then placed over the wire after the microsheath was removed. Balloon dilatation of the cephalic arch was then performed with a 8 mm x 6 cm balloon. Postvenoplasty venogram demonstrates residual stenosis. A 10 mm x 6 cm balloon was then passed over the wire and venoplasty was then performed of the cephalic vein as well as the brachiocephalic
vein. Postvenoplasty venogram demonstrates residual stenosis at the brachycephalic vein. Venoplasty was then performed with a 12 mm x 4 cm balloon after the sheath was upsized to an 8 French sheath. Postvenoplasty venogram demonstrates no significant residual stenosis of the brachiocephalic or cephalic vein. The Kumpe catheter was then attempted to be advanced into the brachial vein however, this was not possible beyond the
mid humerus. DSA was then obtained, which demonstrates multiple chest collaterals.
All catheters and sheath was then removed as manual pressure was applied for hemostasis. Patient tolerated the procedure well without any immediate postprocedure complication.
Complications:
No immediate postprocedure complications.
Impression:
Stenosis of the cephalic arch and left brachiocephalic vein, which was successfully venoplastied as above.
Patient likely has brachial vein thrombus, ultrasound examination will be performed and dictated separately.
36147, 35475, 75962
Procedure:
1. Left upper extremity fistula venous outflow access
2. Left upper extremity arteriovenous fistulogram
3. Cephalic venoplasty
4. Brachiocephalic venoplasty
5. Post venoplasty fistulogram.
6. Monitored conscious sedation.
Medications:
Versed and fentanyl per nursing records was given for conscious sedation.
Lidocaine 1% local.
Procedure details:
After explanation of risks and benefits, an informed consent was obtained. Patient was then positioned supine
on the fluoroscopy table. 1% lidocaine was then infiltrated with and subcutaneous tissues and with ultrasound
guidance, access into the venous out flow tract was obtained with a 21-gauge micropuncture needle. This was used to pass a microwire. The needle was replaced with a microsheath. The inner dilator of the microsheath and microwire were removed. A DSA was then obtained, which demonstrates no significant venous outflow stenosis.
Further centrally however, there is stenosis of the cephalic arch noted as well as mildly of the brachycephalic vein.
A Glidewire was then advanced into the microsheath and into the IVC. A 7 French sheath was then placed over the wire after the microsheath was removed. Balloon dilatation of the cephalic arch was then performed with a 8 mm x 6 cm balloon. Postvenoplasty venogram demonstrates residual stenosis. A 10 mm x 6 cm balloon was then passed over the wire and venoplasty was then performed of the cephalic vein as well as the brachiocephalic
vein. Postvenoplasty venogram demonstrates residual stenosis at the brachycephalic vein. Venoplasty was then performed with a 12 mm x 4 cm balloon after the sheath was upsized to an 8 French sheath. Postvenoplasty venogram demonstrates no significant residual stenosis of the brachiocephalic or cephalic vein. The Kumpe catheter was then attempted to be advanced into the brachial vein however, this was not possible beyond the
mid humerus. DSA was then obtained, which demonstrates multiple chest collaterals.
All catheters and sheath was then removed as manual pressure was applied for hemostasis. Patient tolerated the procedure well without any immediate postprocedure complication.
Complications:
No immediate postprocedure complications.
Impression:
Stenosis of the cephalic arch and left brachiocephalic vein, which was successfully venoplastied as above.
Patient likely has brachial vein thrombus, ultrasound examination will be performed and dictated separately.