Wiki Av fistula creation w/ligation

[dpumford]

Hello: I would like to verify this

The vascular surgeon does a Brahc/Cephal AV fistula. He then notes there was a large branch coursing into the vein approximately 5 cm above the anastomosis. This was exposed through a second incision, oriented to 90 degree to the anatomic course of the vein. It was ligated with fine slike tie. The fistual remained patent and easily palpable thrill.. The incision was closed.

He would like to bill for the ligation because it is not at the site of the AV fistula but I feel it is part of creating the fistula..

Any thoughts on this would be greatly appreciated...

Thanks so much!

 

[davidskm]

attaching -22

"Anatomical variants could be an appropriate use of the modifier" -22...per Medicare. I would just bill a -22 asking for more money and state the extra work as you did above with the ligation that was needed to finish the fistula.