Do we need to code CPT 35475(radial artery angioplasty) & 75962 for the below procedure in addition to 35476 & 75978-26 or does inflow radial artery angioplasty is included in 35476 itself????Kindly confirm...
History: 63 year old male with end-stage renal disease on
hemodialysis presents with poor flows from his left radio cephalic
native dialysis fistula following hemodialysis.
Procedure in brief: AV shunt study, brachial artery angiogram,
percutaneous angioplasty of inflow radial artery stenosis,
percutaneous angioplasty of arteriovenous anastomotic stenosis,
percutaneous angioplasty of outflow antebrachial vein stenosis,
Procedure and Findings:
After administering local anesthesia to the overlying soft tissue,
crossing 7 French vascular sheaths were placed into the fistula
outflow vein in the forearm under real-time ultrasound guidance.
Contrast injection with digital imaging of the left arm and chest
in the frontal projection was performed. A 4 French Berenstein
catheter and a hydrophilic guide wire were advanced through the
sheath, guided beyond the arteriovenous anastomosis and positioned
within the inflow brachial artery. A brachial artery angiogram was
These images demonstrate patency of a small caliber inflow radial
artery. Severe, irregular narrowing is identified extending from
the arteriovenous anastomosis through the juxta anastomotic
outflow venous segment for approximately 4 cm in length. In
addition, moderate narrowing of the outflow vein extends for an
additional 6 cm in length. Moderate narrowing is identified within
the outflow antebrachial vein just below the elbow. The outflow
basilic vein in the upper arm is widely patent.The central outflow
veins are patent.
After crossing the venous outflow with a floppy guidewire, the
antebrachial venous stenosis was dilated using an 8 mm x 8 cm
angioplasty balloon. The juxta anastomotic stenosis was
sequentially dilated using 6-mm and 8mm by 4-cm Cordis
angioplasty balloons. The inflow radial artery extending for
approximately 6 cm in length was sequentially dilated using a 5 mm
x 4 cm and 6 mm x 4 cm Cordis Extreme angioplasty balloons. An
improved thrill was palpated within the fistula outflow vein at
this time. A final angiogram was performed demonstrating
demonstrating brisk flow through the fistula with minimal residual
irregularity at the angioplasty sites. The sheaths were removed
and hemostasis was obtained with manual compression.
Angiographic evaluation of left radiocephalic native dialysis
fistula demonstrating inflow radial artery arteriovenous
anastomotic, juxta anastomotic and outflow venous stenoses as
described above. The central outflow veins are widely patent.
Successful percutaneous angioplasty of the above mentioned lesions
using 5 mm, 6 mm and 8 mm diameter high pressure angioplasty
balloons as described above.
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