# ??Ligation of venous tributaries



## ksb0211 (Feb 22, 2011)

Hoping for some input.  I had recd some information that suggested using an unlisted CPT, but I just wanted the opinions of another coder or two.  Here's the scrubbed op report:

Procedure: 
Ligation of venous tributaries with fluoroscopy & intraoperative ultrasound

Description:
We identified a small venous tributary on the dorsum of the hand and we were able to cut down on this, cannulate it, and place and Intracath into that vessel.  We then shot an intraoperative fluoroscopic shuntogram and demonstrated numerous venous tributaries.  We had marked the arm out with needles and marked thos sites.  Once that was done we ligated off our wrist tributary which was a major tributary stealing flow from our fistula.  We went down the arm at our predetermined location and with intraoperative ultrasound guidance further delineated where these tributaries were.  We ligated off a total of four additional tributaries, one of them quite large.  At the completion of the procedure the patient had a very strong thrill at the wrist and we had basically a blood-less procedure.....

Thanks again for your time.
~Kelly


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## susanp (Feb 23, 2011)

Code 35190 could be the one for this procedure.


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