# brachial artery angioplasty



## prabha (Jul 16, 2010)

Kindly confirm my codes,

35475
36120
75962-26
75710-2659
       Left Upper Extremity Arteriogram:       
       Clinical History: 77-year-old male with end-stage renal disease on
       hemodialysis with a left upper extremity brachiocephalic
       hemodialysis AV fistula with steal syndrome status post AV
       fistulagraphy and left upper extremity arteriography demonstrating
       stenoses within the axillary artery and the brachial artery just
       beyond the AV anastomosis with percutaneous angioplasty of the
       axillary artery stenosis on 06/28/2010.
        patient presents for left upper extremity arteriography
       and percutaneous angioplasty of the brachial artery stenosis.

       Procedure and Findings:            
       The left upper extremity was prepped and draped in the usual
       sterile fashion.  After the administration of local anesthesia and
       under ultrasound guidance, access into the mid upper arm brachial
       artery was obtained with a 21-gauge micropuncture set in a
       retrograde fashion.  A Bentson wire was advanced through the
       transition dilator which was exchanged for a 4-French vascular
       sheath.

       A 4-French Berenstein catheter was then advanced over the wire and
       position within the brachial artery just central to the AV
       anastomosis of the brachiocephalic AV fistula.  A gentle injection
       of contrast was then performed confirming good positioning of the
       catheter just central to the AV anastomosis and demonstrating the
       brachial artery distal to the AV anastomosis.

       A straight glide wire was advanced through the Berenstein catheter
       and the catheter and Glidewire were used to gently cross the known
       high grade stenosis within the mid brachial artery just beyond the
       level of the AV anastomosis.  A gentle injection of contrast
       confirmed good positioning of the distal tip of the catheter
       within the distal brachial artery beyond the AV anastomosis and a
       focal stenosis.

       An 014 wire was advanced through the catheter and down the ulnar
       artery.

       A pullback arteriogram with compression of the AV fistula outflow
       vein was then performed which demonstrated the focal high-grade
       stenosis of the mid brachial artery just distal to the AV
       anastomosis.  The Berenstein catheter was then readvanced over the
       wire and positioned within the distal brachial artery.

       A distal left upper extremity arteriogram, utilizing digital
       subtraction angiography, was then performed.
       This demonstrated a focal, a mild, stenosis within the distal
       brachial artery likely related to spasm.  The distal brachial
       artery was otherwise widely patent.  The inter-osseous artery was
       widely patent.  The ulnar artery was widely patent to the level of
       the wrist.  The radial artery was not identified.  The deep and
       superficial palmar arch were widely patent.  The metacarpal
       digital arteries, the common digital arteries, the proper digital
       arteries, the radialis indicis artery appeared widely patent.  The
       princeps pollicis artery was not identified.

       The indwelling Berenstein catheter was then removed over the 014
       wire.  30 mg of intra-arterial papaverine and 1 mL of normal
       saline was then administered via the indwelling sheath.

       Serial dilatation of the focal, high-grade, stenosis within the
       mid brachial artery was then performed with a 4 mm x 4 cm
       angioplasty balloon.

       The angioplasty balloon was then exchanged for the 4-French
       Berenstein catheter which was positioned within the brachial
       artery just central to the AV anastomosis.

       A post intervention left upper extremity arteriogram, utilizing
       digital angiography, was then performed via the indwelling
       catheter.  This demonstrated a good result with white luminal
       patency of the mid brachial artery.  A focal, moderate on the
       stenosis in the distal brachial artery was identified likely
       secondary to spasm.

       The Berenstein catheter was then advanced beyond the AV
       anastomosis into the mid brachial artery.  An additional 30 mg of
       intra-arterial papaverine in 1 mL of normal saline was
       administered through the indwelling catheter.  The indwelling
       catheter was then removed.

       Percutaneous submaximal balloon inflation angioplasty of the focal
       area of spasm within the distal brachial artery was then performed
       with a 4 mm x 4 cm angioplasty balloon.  The angioplasty balloon
       was then removed and exchanged for the Berenstein catheter which
       was positioned within the brachial artery just central to the AV
       anastomosis of the AV fistula.

       A repeat left upper extremity arteriogram, with compression of the
       outflow vein of the AV fistula, was then performed via the
       indwelling catheter.  This demonstrated a good result with white
       luminal patency of the mid and distal brachial artery.  The
       angioplasty the focal high-grade stenosis within the mid brachial
       artery just beyond the AV anastomosis appeared widely patent.  The
       focal area of spasm within the distal brachial artery appear
       widely patent.

       A final post-intervention left upper extremity arteriogram,
       utilizing digital subtraction angiography, was then performed.

       This demonstrated wide luminal patency of the mid and distal
       brachial artery.  A high origin the radial artery was identified
       just central to the AV anastomosis and appear grossly patent.  The
       ulnar artery and interosseous artery appeared widely patent with
       no filling defects identified to suggest distal embolization.

       The deep and superficial palmar arches and the digital arteries of
       the hand appeared widely patent with no filling defects to suggest
       distal embolization.  The princeps pollicis artery is now
       identified and is widely patent.  Reflux retrograde flow up the
       widely patent radial artery is identified.

       The catheter was then removed.  After normalization of coagulation
       parameters the sheath was removed and hemostasis was obtained with
       direct manual compression.
       Impression:       
       Left upper extremity arteriography demonstrating a focal
       high-grade stenosis within the mid brachial artery just distal to
       the AV anastomosis of the brachiocephalic fistula as described
       above.  High origin of the radial artery originating from the
       brachial artery just central to the AV fistula AV anastomosis as
       described above.

       Successful treatment of the above described brachial artery
       stenosis with percutaneous angioplasty up to 4 mm as described
       above.


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## HNISHA (Jul 29, 2010)

I would prefer the same set of codes....

Thanks,
Abdul Saleem CPC


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## dpeoples (Jul 29, 2010)

prabha said:


> Kindly confirm my codes,
> 
> 35475
> 36120
> ...



IMO, this is an AV fistulogram with angioplasty. I would code:
35475/75962
36147

HTH


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