Agrant77
New
SC Medicaid is denying G2170 from 12/14/2022 stating code is not covered. As of 1/1/23, the new code is now 36836. What should I submit?
PROCEDURE:
1. Percutaneous left proximal radial artery fistula
2. Percutaneous transluminal balloon angioplasty of arterial anastomosis
3. AV access catheter and contrast
4. Venogram
5.Venous angioplasty of access, Angioplasty proximal radial artery anastomosis , and Open band ligation basilic vein
6. Supervision and Interpretation of fluoroscopic imaging
Anesthesia Type: MAC, local, regional
Proximal Radial Artery 3.0 mm.
Vein 3.0 mm.
Anastomotic length/diameter 5 mm.
Percutaneous venous access anatomy was appropriate. Using ultrasound guidance the deep cephalic perforating vein was entered. Permanent images were stored. The access needle was advanced into the proximal radial artery allowing for placement of a guidewire into the artery. The needle was removed and an access sheath was advanced into the artery.
Ellipsys Catheter was advanced over the guidewire until the tip was positioned within the proximal radial artery. The catheter was then positioned between the artery and vein. Light tension was applied to the catheter to ensure the tip was seated against the arterial wall. The artery and vein were captured and the device is closed. The Ellipsys Catheter was activated and fistula was created. Completion ultrasound was performed.
DETAILS:
Micropuncture technique was used to cannulate the access, a guide wire was
placed. Seldinger exchange allowed introducer working sheath introduction
to cannulate distal radial artery under ultrasonic guidance for Ellipsys AV fistula flow evaluation with fluoroscopy.
ARTERIOGRAM, VENOGRAM OF ACCESS, EXTREMITY, AND CENTRAL VEINS:
Utilizing the working sheath, dilute radiocontrast and sequential flouroscopic images were obtained from the distal radial artery from the working sheath. An arteriogram was then performed using selective catheterization over guidewire from the proximal brachial artery to evaluate the outflow arterial tree and proximal radial arterial fistula All visualized vessels were normal except those mentioned.
OPERATIVE FINDINGS:
PRIMARY LESION: tandem, arterial inflow, arterial anastomosis, and perforator
STENOSIS: 50%
LENGTH: 2 cm.
TREATMENT: Treatment of the effected vasculature was rendered using guidewire and fluoroscopy with sequential imaging"
ANGIOPLASTY: Chameleon 5 x 40 and Sterling 5 x 20
Abnormal venous collateral flow: Selective catheterization of competing tributary(ies) with pre and post treatment contrasted imaging was performed with sequential fluoroscopic images
Open tributary ligation:
With wire in place ultrasound guidance was used to create a longitudinal incision along the median basilic vein. Soft tissues were dissected unremarkably using blunt dissection and Bovie electric coagulation. Band ligation of basilic vein was carried out using 5-0 Gore-Tex suture over a 035 advantage guidewire. Angiography was re-performed demonstrating near complete obliteration of collateral blood flow through venous runoff and returning the access to a monofistula.
Wounds were subsequently closed in layers with 3-0 Monocryl suture and dermabond
PROCEDURE:
1. Percutaneous left proximal radial artery fistula
2. Percutaneous transluminal balloon angioplasty of arterial anastomosis
3. AV access catheter and contrast
4. Venogram
5.Venous angioplasty of access, Angioplasty proximal radial artery anastomosis , and Open band ligation basilic vein
6. Supervision and Interpretation of fluoroscopic imaging
Anesthesia Type: MAC, local, regional
Proximal Radial Artery 3.0 mm.
Vein 3.0 mm.
Anastomotic length/diameter 5 mm.
Percutaneous venous access anatomy was appropriate. Using ultrasound guidance the deep cephalic perforating vein was entered. Permanent images were stored. The access needle was advanced into the proximal radial artery allowing for placement of a guidewire into the artery. The needle was removed and an access sheath was advanced into the artery.
Ellipsys Catheter was advanced over the guidewire until the tip was positioned within the proximal radial artery. The catheter was then positioned between the artery and vein. Light tension was applied to the catheter to ensure the tip was seated against the arterial wall. The artery and vein were captured and the device is closed. The Ellipsys Catheter was activated and fistula was created. Completion ultrasound was performed.
DETAILS:
Micropuncture technique was used to cannulate the access, a guide wire was
placed. Seldinger exchange allowed introducer working sheath introduction
to cannulate distal radial artery under ultrasonic guidance for Ellipsys AV fistula flow evaluation with fluoroscopy.
ARTERIOGRAM, VENOGRAM OF ACCESS, EXTREMITY, AND CENTRAL VEINS:
Utilizing the working sheath, dilute radiocontrast and sequential flouroscopic images were obtained from the distal radial artery from the working sheath. An arteriogram was then performed using selective catheterization over guidewire from the proximal brachial artery to evaluate the outflow arterial tree and proximal radial arterial fistula All visualized vessels were normal except those mentioned.
OPERATIVE FINDINGS:
PRIMARY LESION: tandem, arterial inflow, arterial anastomosis, and perforator
STENOSIS: 50%
LENGTH: 2 cm.
TREATMENT: Treatment of the effected vasculature was rendered using guidewire and fluoroscopy with sequential imaging"
ANGIOPLASTY: Chameleon 5 x 40 and Sterling 5 x 20
Abnormal venous collateral flow: Selective catheterization of competing tributary(ies) with pre and post treatment contrasted imaging was performed with sequential fluoroscopic images
Open tributary ligation:
With wire in place ultrasound guidance was used to create a longitudinal incision along the median basilic vein. Soft tissues were dissected unremarkably using blunt dissection and Bovie electric coagulation. Band ligation of basilic vein was carried out using 5-0 Gore-Tex suture over a 035 advantage guidewire. Angiography was re-performed demonstrating near complete obliteration of collateral blood flow through venous runoff and returning the access to a monofistula.
Wounds were subsequently closed in layers with 3-0 Monocryl suture and dermabond