• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below..
  • Important Note: We will be performing a scheduled maintenance on 1st November 2020. The site will be offline from 7:30PM (MT) till midnight. We apologize for any inconvenience this may cause.

Infected graft with patch repair Help!

dpumford

Expert
Messages
299
Best answers
0
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!
 

jewlz0879

True Blue
Messages
823
Location
Richardson, TX
Best answers
0
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.
 
Top