I have a question about nitroglycerin being injected during an AV fistulogram.
I have billed code 36147 but can I code for the injection of nitroglycerin or for the subsequent fistulogram and venogram?
Here is the op note:
DIAGNOSES:
1. Inadequate maturation of left AV fistula.
2. Multiple collateralization of the veins in the upper arm with multiple stenoses of these. Good axillary and AV fistula areas but connecting these is very poor venous collaterals.
PROCEDURES:
1. Left venotomy/fistulotomy with micropuncture antegrade.
2. Fistulogram with runoff to the right atrium x3.
3. Injection of nitroglycerin with subsequent fistulogram and venogram after this; this showed no improvement.
4. Manual hemostasis of vascular access site.
FINDINGS:
1. The patient is a very difficult stick. After multiple tries, the fistulotomy was performed. The arterial anastomosis site looks open and patent and the proximal 3 cm of the fistulogram appears to be normal.
2. From the proximal 3 cm to the axillary vein, there appears to be multiple collaterals of very small caliber and very tortuous. There appears to be no large vein connecting these.
3. Brachial vein to right atrium appears to be of good quality and caliber. These vessels connecting the proximal fistula to the axillary vein are tiny, thread-like, small diameter and very tortuous.
4. After nitroglycerin injection, there was no improvement in the size, quality, or caliber of these collateral vessels.
Thanks. Lisa
I have billed code 36147 but can I code for the injection of nitroglycerin or for the subsequent fistulogram and venogram?
Here is the op note:
DIAGNOSES:
1. Inadequate maturation of left AV fistula.
2. Multiple collateralization of the veins in the upper arm with multiple stenoses of these. Good axillary and AV fistula areas but connecting these is very poor venous collaterals.
PROCEDURES:
1. Left venotomy/fistulotomy with micropuncture antegrade.
2. Fistulogram with runoff to the right atrium x3.
3. Injection of nitroglycerin with subsequent fistulogram and venogram after this; this showed no improvement.
4. Manual hemostasis of vascular access site.
FINDINGS:
1. The patient is a very difficult stick. After multiple tries, the fistulotomy was performed. The arterial anastomosis site looks open and patent and the proximal 3 cm of the fistulogram appears to be normal.
2. From the proximal 3 cm to the axillary vein, there appears to be multiple collaterals of very small caliber and very tortuous. There appears to be no large vein connecting these.
3. Brachial vein to right atrium appears to be of good quality and caliber. These vessels connecting the proximal fistula to the axillary vein are tiny, thread-like, small diameter and very tortuous.
4. After nitroglycerin injection, there was no improvement in the size, quality, or caliber of these collateral vessels.
Thanks. Lisa