Wiki Infected graft with patch repair Help!


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Hi! I hope someone can assist me with this :)

Pt had a "Excision of graft fitula, left forearm with vein patch repair of the distal brachial artery". Graft was infected and chroniclly-thrombosed.

Incision made over the anatomic course of the brachial artery, beginning in the distal arem extending across the antecubital fossa into the proximal forarm. deepened into the subcutaneous tissues.

Incision was deepened proximally and the brachial artery above the level of the graft was exposed and looped with vessel loops. The distal portion of the excision was then depened and the graft remnant identified and traced up to the level of the brachial artery.. The graft and this brachial artery anastomosis were exposed and the patient given heparin.

After 3 minutes the graft and its surrounding sheath were excised in their entiretys the previous core suture identified and transected. There was septated & lysed thrombus at the anastomitic site and the was excised & longitudinal arteriotomy was made prox & distally.

The Brachial vein was harvested and opened longitudinally. It was used for a vein patch closure for the distal brachial artery.

I am coding 35903 but should I code 35236? Im thinking incl'd in but the surgeon think we should code it. Also was wondering if coding the thrombectomy 36831 would be correct since thrombus was removed.:confused:

Any advice would be greatly appreciated...Wish I could get Dr. Z vascular book :)...

Thanks bunches!
I wouldn't bill 36831 because that's for an actual fistula revision and in your case the fistula graft was completely removed bc of the chronic thromobis.

I agree with 35903. I don't think 35236 should be billed since it is for an injury to b.v.