suela923@aol.com
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Would you bill 36147 or 36147-74 (I am billing for the facility).
I felt this was a discontinued procedure....???? Thanks, Sue
Preoperative diagnosis: Malfunctioning right upper extremity AV fistula
Postoperative diagnosis: Thrombosed right upper extremity AV fistula
Procedure: Right upper extremity fistulogram
Indications for procedure: This is a 61-year-old male with a right basilic vein transposition fistula through which he performs home dialysis. There was difficulty accessing his fistula and fistulogram was requested.
Details of the procedure: The patient was identified and placed supine on the angiography table. The right arm was prepped and draped in the usual sterile fashion. After injection of 2% lidocaine, the right arm fistula was attempted to be accessed with a micropuncture needle. This was found to be very difficult; therefore, ultrasound guidance was employed for fistula access. Images were saved for documentation. Ultrasound images noted the very proximal part of the fistula near the arterial anastomosis appeared to be patent; however, the remainder of the fistula appeared thrombosed. Needle was inserted under ultrasound guidance into the fistula where some blood return was obtained. Wire access was attempted; however, this was not successful. Contrast run through the needle was performed and noted patent brachial artery; however, there did not appear to be any flow in the fistula. At this point the procedure was terminated with plans for operative revision and possible tunneled catheter placement. Manual compression was used for hemostasis. The patient tolerated the procedure well with no immediate complications.
Findings:
1. Patent right brachial artery.
2. Thrombosed right basilic vein transposition AV fistula.
I felt this was a discontinued procedure....???? Thanks, Sue
Preoperative diagnosis: Malfunctioning right upper extremity AV fistula
Postoperative diagnosis: Thrombosed right upper extremity AV fistula
Procedure: Right upper extremity fistulogram
Indications for procedure: This is a 61-year-old male with a right basilic vein transposition fistula through which he performs home dialysis. There was difficulty accessing his fistula and fistulogram was requested.
Details of the procedure: The patient was identified and placed supine on the angiography table. The right arm was prepped and draped in the usual sterile fashion. After injection of 2% lidocaine, the right arm fistula was attempted to be accessed with a micropuncture needle. This was found to be very difficult; therefore, ultrasound guidance was employed for fistula access. Images were saved for documentation. Ultrasound images noted the very proximal part of the fistula near the arterial anastomosis appeared to be patent; however, the remainder of the fistula appeared thrombosed. Needle was inserted under ultrasound guidance into the fistula where some blood return was obtained. Wire access was attempted; however, this was not successful. Contrast run through the needle was performed and noted patent brachial artery; however, there did not appear to be any flow in the fistula. At this point the procedure was terminated with plans for operative revision and possible tunneled catheter placement. Manual compression was used for hemostasis. The patient tolerated the procedure well with no immediate complications.
Findings:
1. Patent right brachial artery.
2. Thrombosed right basilic vein transposition AV fistula.