It seems the more I read about vascular coding the more confused I become when it comes to ANY dialysis circuit interventions. Physician wants to bill 36832 (Revision, open, arteriovenous fistula; without thrombectomy, autogenous or nonautogenous dialysis graft (separate procedure)) but I don’t see it. I don’t see where he is doing any revision; only angioplasty.
I think the correct codes for the intervention would be 36901, and 36907 but I wanted to be sure.
Op report reads:
After informed consent was obtained patient was taken the operating room and prepped and draped in usual sterile manner. The cephalic vein was marked on the skin with ultrasound guidance and a longitudinal incision was made overlying the cephalic vein down to the anastomosis with the radial artery. The subcutaneous tissue was divided with the cautery and the cephalic vein was dissected circumferentially using sharp dissection. A skin flap approximately 3-4 mm in thickness was made and the subcutaneous tissue closed with running 3-0 Vicryl deep to the vein. A micropuncture set was used to access the fistula and a antegrade fashion and a fistulogram was performed with the findings as noted above. A 0.018 Roadrunner guidewire was advanced through the fistula and retrograde up the radial artery past the stenosis. The stenosis was balloon to 8 atm with a 3 mm angioplasty balloon. No residual stenosis was noted the proximal vein up to the innominate vein was interrogated and no significant stenosis identified. The sheath was removed and hemostasis controlled with a figure-of-eight suture. The wound was irrigated and an additional subcutaneous layer was used to approximate the tissues over the vein followed by a running subcuticular 4-0 Monocryl. A sterile dressing was placed over the incision and the patient returned to the recovery room in stable condition. Plan is to admit overnight for dialysis in the morning and then discharged home.