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Thread: New dialysis access codes "help"

  1. #1
    Join Date
    Apr 2007

    Default New dialysis access codes "help"

    AAPC: Back to School
    Good Morning,

    I am hoping someone could assist me on this report, I am so

    INDICATIONS: 76 year-old gentleman with end stage renal disease and
    a functioning left forearm AV fistula for the last several weeks but
    recently they have noticed significant increased venous pressures and
    inability to obtain dialysis earlier this morning. He has a native
    fistula that is a basilic vein that was looped in the forearm and
    anastomosed to the brachial artery just below the antecubital crease.

    OPERATIVE DETAIL: Patient was identified in the holding area and
    brought back to the Endovascular suite and placed on the table in a
    supine position. His left hand was prepped and draped out in a
    sterile fashion. The dialysis needles were left in place to
    potentially facilitate therapy. Essentially two 16 gauge needles
    were placed going in opposite directions in the ulnar side of the
    forearm. Through both needles dye was injected. This showed a
    basilic vein based fistula in the forearm which was essentially
    looped from the ulnar side to the radial side connecting to the
    radial artery. The proximal half of the fistula was diffusely
    narrowed until the loop where the distal half was nicely patent and
    of good size. Percutaneous access was then obtained. We were able
    to place a J-wire through the arterial needle in essentially
    retrograde access. The 6-French sheath was then placed over this
    wire. We needed a glidewire to manipulate through the diffuse
    narrowing through the arterial anastomosis into the brachial artery
    near the elbow. A 5 mm x 6 cm balloon was chosen. Balloon
    angioplasty was performed of the arterial anastomosis as well as the
    entire half of the loop graft which was diffusely narrowed.
    Prolonged angioplasty at 3 minute insufflations was performed. Final
    insufflation at the loop where a very focal high grade stenosis was
    noted. Completion fistulogram showed excellent results of the
    proximal portion of the fistula. Through the same access site we
    looked more proximal in the upper arm as well as the central veins
    thus performing a central venogram. In the upper arm patient had a
    nicely enlarged basilic vein that could be used for future dialysis.
    Cephalic vein was not seen but patency could be possible. The
    basilic vein dove nicely into the axillary and subclavian vein which
    fed into the central veins without any evidence of stenosis. The
    6-French sheath was removed and 3.0 Vicryl u-stitch was placed. The
    venous outflow dialysis needle was still in place and this was
    removed and 3.0 Vicryl u-stitch was placed. Pressure was held for 10
    minutes with good hemostasis. Sterile gauze dressing was placed.
    Patient had a nice thrill throughout the fistula without any
    complaints of pain or discomfort in his arm. Patient tolerated
    procedure well and went to recovery in stable condition.

  2. #2
    Join Date
    Apr 2007

    Default New Dialysis access codes

    Any takers on this????

    The patient came in to the Endo Suite with the access already in. The Doc injected contrast into both needles for a Fistulagram. Would that be a 75791? Then he did an Angioplasty of the graft from another access would I code a 36140 and 75978 & 35476? Am I on the right track?

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