# Right Arteriovenous fistulogram



## andersonja (Dec 10, 2010)

Coding assistance needed:

Procedure Performed: Right arteriovenous fistulogram

Indications: AV fistula which is immature and dysfunctional, unable to be used for hemodialysis.

Anatomical Site: Right arm

Anesthetic: Local

Procedure Steps: Consent obtained from patient.  The patient was prepped and draped in sterile fashion.  Using 1% lidocaine for local anesthesia, dialysis access was attempted to be cannulated using micropuncture kit.  The 21-gauge needle was exchaned over a wire to 5-French catheter in venous direction.  A fistulogram was performed which showed that there were multiple collaterals and veins originating around the old graft attachment site.
The rest of the fistula was nicely developed, approx. 8 to 10 mm in diameter.  The fistula continued outward as outflow vein.  This vein continued as subclavian vein.  There was central stenosis of right innominate vein.  There was a catheter noted from the left IJ and sitting in the right atrium as well.  The inflow could not be assessed as there were multiple branches which were originating close to the inflow.  The catheter was removed and hemostasis was achieved by digital pressure.  A quick ultrasound was also done which showed that the fistula was deep, more thatn 1 cm throughout the course.

Post Op Condition: Stable
estimated Blood Loss: 5mL.
Specimens: None
Complications: None
Fluids Given: None

Contrast Used: Ominpague 20mL.

Plan:
1. We will not use AV fistula
2. This case will be discussed with the vascular surgeion, regarding the possiblity of any surgical revision.

Thanks in advance to anyone who could assit me with this procedure.


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## Grintwig (Dec 10, 2010)

Have you looked at 75790?


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## kbazarte@yahoo.com (Dec 10, 2010)

code 75790 has been deleted and refers you to 75791 HOWEVER this code is a shuntogram via existing acces

I recommend 36147 AV Shuntogram, the S & I code is included


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## andersonja (Dec 13, 2010)

*Right Arteriovenous Fistula*

I'm sorry I should have included the CPT code the doctor reported: 36147 & 76937..The 76937 is an add on code and i'm not sure what code to report or even if the 76937 is the correct code?   Any suggestions would be greatly appreciated.
Thanks


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## kbazarte@yahoo.com (Dec 14, 2010)

76937 is Ultrasound guidance for vascular access.  Per the report provided there is no documentation of ultrasound access and no documentation of permanent recording of the ultrasound images.

36147 is the only code that he can use, the definition is as follows:

Introduction of needle and / or catherter, arteriovenous shunt created for dialysis (graft / fistula); initial access with complete radiologic evaluation of dialysis access, including flouroscopy, image documentation and report (includes acces of shunt, injection of contrast and all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow, including the inferior or sup[erior vena cava).


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