T82.585A, T82868A, Y83.9, I120, N186, Z992, G47.33
36905, 36909, 37187-59 — Not sure if 36909 should be coded. Really hesitant about 37187-59 also.
Procedure:
1. Fistulogram LU extremity AV fistula
2. Declot with PTA of venous outflow with 6 x 7 and 7 x 60 and arterial inflow with 6 x 6
3. Mechanical thrombectomy with teratola device
Complications: none
Specimens: none
History of present illness:
The patient has a history of chronic kidney disease being dialyzed through a LU extremity AV fistula. This has been functioning well until recently, when they began to have loss of thrill. The patient was consented and scheduled for a declot.
Procedure in detail:
In the angio suite LU extremity was prepped and draped in sterile fashion, and 1% lidocaine was used to anesthetize the skin and subcutaneous tissue overlying the fistula. After which the fistula was accessed using a micropuncture needle followed by wire and catheter, and PTA of the venous outflow was performed. Gentle fistulagram was performed which showed significant stenosis in outflow with was ballooned with 6 x 70 and 7 x 60 balloon after up sizing to a 6Fr sheath. Embolectomy of inflow was performed with fogarty over the wire after sheath was flipped. Balloon angioplasty of arterial end was performed with 6 x 60 balloon. Fistulagram still significant for clot. Teratola used for mechanical thrombectomy.