Help with thrombectomy (vascular) coding

Winston-Salem, NC
Best answers
New CPT codes this year for intro to catheter. I need help to determine if I can bill both 36831 and 36902 (new code).

The patient was brought to the operating room, endovascular suite room 16, placed in the supine position. Under satisfactory level of LMA general anesthesia, the left upper extremity was prepped with ChloraPrep and draped as a separate sterile field. A transverse incision was made at the antecubital fossa just above the antecubital skin crease. A 3 cm length incision was used to expose the native cephalic vein over a 2-cm length. This was isolated proximal and distal with vessel loops. Heparin 3000 units were given. Transverse venotomy made in the cephalic vein and I passed the Fogarty balloon downward toward the artery and no thrombus noted. I passed a 4-mm dilator through the anastomosis and this passed easily. There was strong arterial inflow. I then passed a #4 Fogarty balloon up the vein and through the venous outflow tract. Initially, it was difficult to pass through the Gore-Tex graft segment, but I was eventually able to accomplish this. I pulled down multiple segments of thrombus. There appeared to be more thrombus than would fit into this vein segment, but after multiple passes, we had no additional thrombus. I then flushed with heparinized saline and there was good flow noted. I placed a 5-French sheath and proceed with AV fistulogram.
Radiographic findings on the AV fistulogram with injection of contrast and digital subtraction angiography showed a focal stenosis in the cephalic vein at the top end of the Gore-Tex graft at the mid biceps. This appeared to be a severe stenosis and had some associated thrombus. It was also suggestive of stenosis in the cephalic vein just at the point that the cephalic vein empties into the axillary vein. Based on the size of the Gore-Tex graft, we selected a 6 x 60 mm balloon. A 0.035 Bentson wire was easily advanced through these lesions and into the central venous circulation. Incidentally, the central venous circulation showed no evidence of stenosis beyond this. I then used a 6 x 6 mm balloon to dilate these stenotic areas. I dilated to burst pressure which was 6.35 mm diameter and there was a waist noted at the cephalic vein near the axillary vein, but minimal waist noted at the cephalic vein at the mid biceps. This suggested that the mid biceps lesion was mostly just residual that was perhaps some residual thrombus. Therefore, after balloon dilation, I injected contrast for a repeat AV fistulogram and noted improvement in both the stenosis at the mid biceps and near the axillary vein. I felt this was a reasonably good end point, but to help with the residual thrombus in the cephalic vein, I injected thrombolytic TPA 2 mg injected into the AV fistula and then allowed this to dwell while we close the venotomy. The venotomy was closed with multiple interrupted 6-0 Prolene sutures. Once these were tied down, flow was reestablished and there was a good excellent and palpable thrill at the antecubital fossa. I felt this would be an adequate endpoint. The subcutaneous tissue was closed with 3-0 Vicryl interrupted and skin closed with intradermal 4-0 Monocryl. Mastisol, Steri-Strips, sterile dressing applied with Telfa and Tegaderm occlusive dressing. The patient was subsequently extubated and taken to the recovery room in stable condition.