# a/v fistula



## racheleporterwilliams (Apr 21, 2008)

I'm new at this....can't find the correct procedure code....please read procedure note below (58 y/o Medicare A/B)....thanx for any input/insight 

*Pre-procedure Diagnoses 
1. COMPLICATION DUE TO RENAL DIALYSIS GRAFT (996.73) 

  Post-procedure Diagnoses 
1. COMPLICATION DUE TO RENAL DIALYSIS GRAFT (996.73) 

  Procedures 
1. DECLOTTING OF ARTERIOVENOUS FISTULA (221627) 

Procedure:  Left upper arm a/v fistula declotting.
Radiologist:  MD
Findings:  There is a thrombosed left upper arm a/v fistula. Attempt at declotting the fistula with 3mg of TPA and Teratola device was unsuccessful due to large clot burden. There were severe moderate stenosis of the fistula between the aneurysm treated with 8mm balloon dilatation. There is a severe stenosis to the draining cephalic vein in the chest just prior to the subclavian vein, however a wire pass with ease centrally.  This was not treated yet for fear of Pulmonary embolism.   A 10 cm infusion catheter was placed across the thrombosed fistula with urokinase infusion initiated at 30ml/hour ( 60,000 units/ hour.)  Patient was started on heparin at 1000 units and hour.  

Plan:  Follow up urokinase thrombolysis in AM with possible angioplasty of central cephalic stenosis with successful. *


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## dpumford (Apr 21, 2008)

Hello,  You may want to check out procedure code 37201 and S & I code 
75896-26.  This is used for Urokinases other than coronary. You can also code for the catheter placement.

 You may also code 75898-26 Angio thru and existing catherter for follow-up study for transcatheter therapy.  

There is a percutaneous AV thrombectomy, mechanical thrombus extraction  code 36870 that you should also review.

Hope this points you in the right direction.


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## vikas.maheshwari (Jun 20, 2008)

oooooooooops


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