Question I am new to vascular surgery coding and really confused on a sx to be coded.I would truly appreciate if anyone can help me to obtain correct CPT code

OGGPPL

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Procedure: RIGHT ARM ARTERIOVENOUS ARTEGRAFT BOVINE PLACEMENT

Procedure Details:
Discussed with patient the natural history of the disease and and the pathophysiology and all relevant issues associated to with the problem at hand.

All complications major and minor were discussed including bleeding infection and limb loss.

All questions and concerns were addressed along with realistic expectations.

Patient expressed to a strong desire through the understanding of the information given to him and wishes to proceed with the operative intervention

The left arm is no longer accessible for a a because of lack of venous outflow tract.

The right arm on duplex scanning the basilic vein was noted to be patent. However there is a significant amount of fibrotic reaction is noted in the subcutaneous tissue with least a 30 degree flexion contraction of the right elbow .

Given his general condition and health. Flexion contraction of the right arm would recommend a bridging AV graft.

The venous reconstruction will not be available satisfactorily because of the fibrotic type reaction noted in his right upper extremity.

Incision was made in the right axilla cutting the skin subcutaneous tissue again subcutaneous fibrotic type reaction was noted the deep fascia was divided the axillary vein was identified was noted to be at least 8 mm in diameter.

Incision was then made in the right antecubital fossa because of the contraction at the elbow and similar amount of fibrotic reaction noted in the subcutaneous tissue the brachial artery was isolated the artery was noted to be at least 4 mm in diameter proximal distal control was obtained. There was at least 3 mm brachial vein that was noted however given the condition of her skin and subcutaneous tissue a autologous fistula would not be in his best interest.

Quarter percent Marcaine was infiltrated subcutaneously a lateral incision lateral subcutaneous tunnel was made in the right upper arm again because of the fibrotic reaction noted in the subcutaneous tissue this tunnel was made carefully using the Kelly-Wick dilator apparatus.

Patient was given 4000 units of heparin intravenously the brachial artery was isolated proximally and distally longitudinal arteriotomy was made the brachial artery was noted to have some sclerotic walls end-to-side anastomosis between the BOVINE graft was made to the brachial artery using 6-0 Prolene suture and the 2 suture technique after completion of the anastomosis the graft was then tunneled subcutaneously in preparation for anastomosis with the axillary vein end-to-side anastomosis was performed using 6-0 Prolene suture and the 2 suture technique to the axillary vein

The bovine graft was easily palpated in its subcutaneous location wound was irrigated with antibiotic solution subcutaneous tissue approximated with 3-0 Vicryl skin with interrupted 3-0 nylon suture

Mupirocin cream and an OpSite dressing was placed followed by Kerlix patient had a palpable right radial pulse and Doppler flow in the hand.
 
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