# PTA and mechanical thrombectomy AV fistula



## dkhclement (Jun 15, 2018)

Good morning – Could someone please review the codes I chose for this op note?  Dx and CPT codes, please.  Pt with AV fistula, lost thrill, ESRD, HTN, OSA.  Um….I’m thinking I may need another complication of procedure code for what he states was an inadvertant brachial artery embolism with retrieval and restoration of flow noted below in Findings.  Is Y83.9 appropriate?  Many thanks.  Kristi

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.


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## Jim Pawloski (Jun 18, 2018)

dkhclement said:


> Good morning – Could someone please review the codes I chose for this op note?  Dx and CPT codes, please.  Pt with AV fistula, lost thrill, ESRD, HTN, OSA.  Um….I’m thinking I may need another complication of procedure code for what he states was an inadvertant brachial artery embolism with retrieval and restoration of flow noted below in Findings.  Is Y83.9 appropriate?  Many thanks.  Kristi
> 
> T82.585A, T82868A, Y83.9, I120, N186, Z992, G47.33
> 
> ...



All you have is 36905 - Thrombectomy any method w/ angioplasty. Everything was done in the distal shunt segment. The other codes are used for non-dialysis venous procedures.
HTH,
Jim Pawloski, CIRCC


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## dkhclement (Jun 19, 2018)

*Many thanks, Jim.*

I appreciate your feedback.


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