Wiki Clotted avg help pls

[Kisha]

1. Catheterization of the subclavian vein with image.
2. Catheterization of the brachial artery with image.
3. Mechanical thrombectomy of the arteriovenous graft.
4. Angioplasty of the arterial anastomosis in brachial artery.
5. Angioplasty of the vein graft anastomosis with stent placement for stenosis.
35475, 36011, 36215, 37187, 37236
I DON?T THINK 35475 SHOULD BE CODED AS IT IS INCLED IN 37236?

 

[Jim Pawloski]

1. Catheterization of the subclavian vein with image.
2. Catheterization of the brachial artery with image.
3. Mechanical thrombectomy of the arteriovenous graft.
4. Angioplasty of the arterial anastomosis in brachial artery.
5. Angioplasty of the vein graft anastomosis with stent placement for stenosis.
35475, 36011, 36215, 37187, 37236
I DON?T THINK 35475 SHOULD BE CODED AS IT IS INCLED IN 37236?

Can you post the report? Need to know where the access to the graft occured.
Thanks,
Jim Pawloski, CIRCC

 

[Kisha]

clotted AVG report

DESCRIPTION OF THE PROCEDURE: After informed consent was given, the patient was transferred to the procedure area and placed in supine position with the right upper extremity placed on arm rest. The upper extremity was then prepped and draped in a sterile fashion. The skin overlying the AV graft was anesthetized in two areas with 2% lidocaine. The graft was entered in both directions with micropuncture sheath. The guidewire was manipulated into the brachial artery and subclavian vein respectively. The micropuncture sheaths were exchanged for vascular sheaths and an imager was advanced into the subclavian vein. Angiography was performed demonstrating the central venous vasculature. Conscious sedation was administered. A guidewire was inserted and AngioJet catheter was passed in antegrade direction through the AV graft multiple times removing thrombi from the AV graft and then on slow injection of contrast, vein graft anastomosis of 90% is visible. A Mustang 5x4 angioplasty balloon was navigated into the lesion and multiple inflations were performed under direct fluoroscopy. Post procedure angiography demonstrated significant residual stenosis; therefore, the decision was now made to stent this area. Atrium 6x38 mm covered stent was deployed under direct fluoroscopy into the lesion. Post procedure angiogram demonstrated no residual stenosis. AngioJet was now forwarded in retrograde direction towards the arterial anastomosis multiple times removing thrombi from the arterial tree. An imager was advanced into the brachial artery. Angiography was performed demonstrating arterial anastomosis stenosis of 60%. The Mustang 5x4 angioplasty balloon was navigated into the brachial artery and inflations along the brachial artery and arterial anastomosis was performed under direct fluoroscopy. Post procedure angiogram demonstrated residual thrombi within the AV graft. A Trerotola device was utilized to measure the thrombi and aspiration catheter was then utilized to aspirate all thrombi from the AV graft. Post procedure angiogram demonstrated no residual stenosis or thrombosis within the AV graft with a good flow of contrast through the AV graft into the subclavian veins. Therefore, both vascular sheaths were removed. The puncture sites were both closed with 2-0 Ethilon and Z-shaped sutures and hemostasis was obtained. The patient tolerated the procedure well and there were no complications.