# Av graft malfunction and excision of pseudoaneurysm



## donnagullikson (Dec 27, 2016)

How would I code this report?  Patient has ESRD and his AV graft is malfunctioning and the physicians took him to OR to do a right upper extremity AV fistula pseudoaneurysm excision and fistula revision with interposition graft (PTFE).

Incision was created down through the subq tissue using Bovie electrocautery and the previous AV fistula was encircled near the arterial anastomosis using a right angle and umbilical tape.  Next, the distal outflow venous tract was dissected in the upper arm through a transverse 4 cm incision made with a 10 blade scalpel.  Circumferential control of the outflow venous end was then obtained with a right angle dissection.  Next Kelly-Wick tunneler was used to successfully tunnel and 8 mm bypass graft in the subq tissue just lateral to the AV fistula.  Following tunneling the AV graft was clamped near the arterial end and the venous end.  The aneurysms were compressed to allow collapse.  Next the venous outflow vessel was divided and end-to-end anastomosis was created between the PTFE and the venous outflow using a 6-0 prolene suture in running circumferential continuous fashion.  The vessel was backbled into the bypass graft.  The bypass graft was clamped.  Sufficient length was measured and the end-to-end arterial anastomosis was created by dividing the arterial inflow vessel and sewing end-to-end to the PTFE using 6-0 prolene.  This anastomosis was sewn in running continuous fashion.  Next two ellipitical incisions were created using a 10 blade scalpel to successfully excise the aneurysm of the AV fistula.  The skin and subq tissue including the aneurysm were successfully excised with bovie electrocautery and closure of the elliptical skin incision with 3-0 nylon suture in vertical mattress fashion


Thanks for the help.


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## SENTHIL05 (Jan 4, 2017)

*Cpt 36832*



donnagullikson said:


> How would I code this report?  Patient has ESRD and his AV graft is malfunctioning and the physicians took him to OR to do a right upper extremity AV fistula pseudoaneurysm excision and fistula revision with interposition graft (PTFE).
> 
> Incision was created down through the subq tissue using Bovie electrocautery and the previous AV fistula was encircled near the arterial anastomosis using a right angle and umbilical tape.  Next, the distal outflow venous tract was dissected in the upper arm through a transverse 4 cm incision made with a 10 blade scalpel.  Circumferential control of the outflow venous end was then obtained with a right angle dissection.  Next Kelly-Wick tunneler was used to successfully tunnel and 8 mm bypass graft in the subq tissue just lateral to the AV fistula.  Following tunneling the AV graft was clamped near the arterial end and the venous end.  The aneurysms were compressed to allow collapse.  Next the venous outflow vessel was divided and end-to-end anastomosis was created between the PTFE and the venous outflow using a 6-0 prolene suture in running circumferential continuous fashion.  The vessel was backbled into the bypass graft.  The bypass graft was clamped.  Sufficient length was measured and the end-to-end arterial anastomosis was created by dividing the arterial inflow vessel and sewing end-to-end to the PTFE using 6-0 prolene.  This anastomosis was sewn in running continuous fashion.  Next two ellipitical incisions were created using a 10 blade scalpel to successfully excise the aneurysm of the AV fistula.  The skin and subq tissue including the aneurysm were successfully excised with bovie electrocautery and closure of the elliptical skin incision with 3-0 nylon suture in vertical mattress fashion
> 
> ...



Am not sure Try this CPT 36832


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