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AV shunt

  1. Default AV shunt
    Medical Coding Books
    Can somebody please give me some guidance on the following. This dr. is filling in for our normal IR dr, and I'm thinking his dictation is lacking...to say the least!

    AV Dialysis Shunt
    Ultrasound guidance and arteriogram of the left arm
    autologous AV shunt fistula. Indication symptomatic swelling of
    the left arm. ASA class II local lidocaine and moderate
    sedation ultrasound guidance to the fistula is recorded with
    flow on PACS and fistulogram obtained. The patient shows
    multiple stenosis which were all angioplastied with a 10 mm x 4
    mm balloon.

    Findings: on the original arteriogram the patient shows
    multiple sclerosis at the level of the cephalic vein, the
    cephalic arch the innominate and the subclavian vein. No flow
    is seen through the innominate vein itself. The flow return is
    through collaterals. I was able to place a catheter and wire
    and the 10 mm by 4 cm angioplasty balloon to perform
    angioplasty. Balloon angioplasty performed at the level of the
    left innominate vein. The subclavian vein. The cephalic vein.
    This where the stents are No complications the arterial
    anastomosis is patent. Aneurysmal enlargement at the level of
    the proximal vein noted.

    Summary: Significant outflow stenosis which was addressed by
    multiple angioplasties the followup arteriogram shows
    improvement in that there is now in-line flow point through the
    cephalic vein to the subclavian and the innominate vein to the
    SVC ; no complications

    IMPRESSION: Ultrasound guidance and arteriogram of the left
    arm autologous AV shunt fistula. Indication symptomatic
    swelling of the left arm. ASA class II local lidocaine and
    moderate sedation ultrasound guidance to the fistula is
    recorded with flow on PACS and fistulogram obtained. The
    patient shows multiple stenosis which were all angioplastied
    with a 10 mm x 4 mm balloon.

    Findings: on the original arteriogram the patient shows
    multiple sclerosis at the level of the cephalic vein, the
    cephalic arch the innominate and the subclavian vein. No flow
    is seen through the innominate vein itself. The flow return is
    through collaterals. I was able to place a catheter and wire
    and the 10 mm by 4 cm angioplasty balloon to perform
    angioplasty. Balloon angioplasty performed at the level of the
    left innominate vein. The subclavian vein. The cephalic vein.
    This where the stents are No complications the arterial
    anastomosis is patent. Aneurysmal enlargement at the level of
    the proximal vein noted.

    Summary: Significant outflow stenosis which was addressed by
    multiple angioplasties the followup arteriogram shows
    improvement in that there is now in-line flow point through the
    cephalic vein to the subclavian and the innominate vein to the
    SVC ; no complications

  2. #2
    Default
    Quote Originally Posted by cdc1cori View Post
    Can somebody please give me some guidance on the following. This dr. is filling in for our normal IR dr, and I'm thinking his dictation is lacking...to say the least!

    AV Dialysis Shunt
    Ultrasound guidance and arteriogram of the left arm
    autologous AV shunt fistula. Indication symptomatic swelling of
    the left arm. ASA class II local lidocaine and moderate
    sedation ultrasound guidance to the fistula is recorded with
    flow on PACS and fistulogram obtained. The patient shows
    multiple stenosis which were all angioplastied with a 10 mm x 4
    mm balloon.

    Findings: on the original arteriogram the patient shows
    multiple sclerosis at the level of the cephalic vein, the
    cephalic arch the innominate and the subclavian vein. No flow
    is seen through the innominate vein itself. The flow return is
    through collaterals. I was able to place a catheter and wire
    and the 10 mm by 4 cm angioplasty balloon to perform
    angioplasty. Balloon angioplasty performed at the level of the
    left innominate vein. The subclavian vein. The cephalic vein.
    This where the stents are No complications the arterial
    anastomosis is patent. Aneurysmal enlargement at the level of
    the proximal vein noted.

    Summary: Significant outflow stenosis which was addressed by
    multiple angioplasties the followup arteriogram shows
    improvement in that there is now in-line flow point through the
    cephalic vein to the subclavian and the innominate vein to the
    SVC ; no complications

    IMPRESSION: Ultrasound guidance and arteriogram of the left
    arm autologous AV shunt fistula. Indication symptomatic
    swelling of the left arm. ASA class II local lidocaine and
    moderate sedation ultrasound guidance to the fistula is
    recorded with flow on PACS and fistulogram obtained. The
    patient shows multiple stenosis which were all angioplastied
    with a 10 mm x 4 mm balloon.

    Findings: on the original arteriogram the patient shows
    multiple sclerosis at the level of the cephalic vein, the
    cephalic arch the innominate and the subclavian vein. No flow
    is seen through the innominate vein itself. The flow return is
    through collaterals. I was able to place a catheter and wire
    and the 10 mm by 4 cm angioplasty balloon to perform
    angioplasty. Balloon angioplasty performed at the level of the
    left innominate vein. The subclavian vein. The cephalic vein.
    This where the stents are No complications the arterial
    anastomosis is patent. Aneurysmal enlargement at the level of
    the proximal vein noted.

    Summary: Significant outflow stenosis which was addressed by
    multiple angioplasties the followup arteriogram shows
    improvement in that there is now in-line flow point through the
    cephalic vein to the subclavian and the innominate vein to the
    SVC ; no complications

    I would bill this as 36147, 35476/75978.
    HTH,
    Jim Pawloski, CIRCC

  3. #3
    Location
    Chennai,Tamilnadu
    Posts
    95
    Smile
    codes are 36147-996.73
    35476-459.2(angioplasty is performed in central veins)
    75978-459.2

  4. Default
    Thanks everybody! This really helps!!

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