suela923@aol.com
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I am being told to bill for the fistulogram with a 52 modifier. I am not so sure I agree as the doctor states this was intervention only. Any advice? Thanks,
Sue
Procedure: Left arm fistulogram. Balloon angioplasty of stenotic segment.
Indication: High venous pressures.
Results: Patient was identified and brought to the vascular unit. The left arm was prepped and draped in the usual sterile fashion. 2% lidocaine was used to infiltrate the skin over the left arm fistula. A micropuncture catheter was placed without difficulty. Fistulography showed severe stenoses in 2 areas in the midportion of the AV fistula.
Note that prior fistulogram was performed. This was an intent to treat procedure. Using a 0.018 guidewire I was able to traverse the stenotic segments were somewhat tortuous. Balloon angioplasty was then performed of the stenotic segments in the midportion of the fistula. Balloon angioplasty was performed to 6 mm, then 8 mm. Completion fistulogram showed significant improvement in the stenotic segments without recoil or residual stenoses. The central veins reviewed as patent without stenoses on a prior study therefore these were not evaluated on this exam.
Result Impression
Severe stenoses in 2 areas of the midportion of the AV fistula. Both successfully treated with balloon angioplasty with good result.
Sue
Procedure: Left arm fistulogram. Balloon angioplasty of stenotic segment.
Indication: High venous pressures.
Results: Patient was identified and brought to the vascular unit. The left arm was prepped and draped in the usual sterile fashion. 2% lidocaine was used to infiltrate the skin over the left arm fistula. A micropuncture catheter was placed without difficulty. Fistulography showed severe stenoses in 2 areas in the midportion of the AV fistula.
Note that prior fistulogram was performed. This was an intent to treat procedure. Using a 0.018 guidewire I was able to traverse the stenotic segments were somewhat tortuous. Balloon angioplasty was then performed of the stenotic segments in the midportion of the fistula. Balloon angioplasty was performed to 6 mm, then 8 mm. Completion fistulogram showed significant improvement in the stenotic segments without recoil or residual stenoses. The central veins reviewed as patent without stenoses on a prior study therefore these were not evaluated on this exam.
Result Impression
Severe stenoses in 2 areas of the midportion of the AV fistula. Both successfully treated with balloon angioplasty with good result.