Can anyone help answer this question?
Per the attached operative note, is the venogram considered inclusive to the fistula?
Post op dx: Renal failure on dialysis, hypertension, congestive heart failure
Procedure performed: Left radiocephalic fistula with a venogram and ligation of 4 major branches
Description of procedure: After informed consent, the patient was taken to the operating room, placed on the OR table in supine position. He had a numb left arm from a previous supraclavicular nerve block in the holding area. The left arm was prepped and draped in the usual sterile manner. 1% plain lidocaine was used to anesthetize the area and an incision was made over the cephalic vein in a curvilinear manner to expose the radial artery. The vein was exposed for about 3-4 cm. The artery was exposed for about 2.5 cm. The artery was controlled proximally and distally with Potts vessel loops. The vein was controlled proximally with a bulldog and distally with a 3-0 silk tie. The vein mobilized easily to the artery. The patient was given a total of 4000 units of heparin and we allowed it 4 minutes circulation time. The artery was then controlled proximally and distally with Potts vessel loops. A venogram was obtained that showed multiple branches. A glow until marking tape radiopaque was used to isolate the branches and mark each of the branches for ligature. There were 4 branches to be ligated. The vein was then mobilized easily to the artery. The artery was opened longitudinally with a #11 blade and Potts scissors. The anastomosis was performed by opening the vein with Potts scissors for 4.5 cm and the anastomosis was performed with a 6-0 Surgipro running simple stitch in a heel-to-toe manner. All the clamps were removed. There were 2 bleeding points that required independent sutures to control the bleeding points in the anastomosis, but otherwise it was fully hemostatic. The branches had been previously marked during the venogram. A separate incision was made over these 4 major branches. Each of the branches were isolated, ligated on each side, and divided. The fistula has a good pulse, thrill and bruit. It lies in a nice gentle curve at the end of the procedure. All each of the incisions were closed with 3-0 Polysorb running stitch in the deep layer, and 4-0 Caprosyn running subcuticular stitch for the skin. Benzoin, Steri-Strips, and dry sterile dressings were applied.
AMA guidelines state "Also included is that portion of the operative arteriogram performed by the surgeon, as indicated."
Would venogram be the same consideration as arteriogram?
When checking my software for bundling it does not show these codes as inclusive to one another however it mentions about the AMA quidelines. This is very confusing to me.
The codes in question are 36821 and 75820.
Any help would be greatly appreciated.
Cheryl
Per the attached operative note, is the venogram considered inclusive to the fistula?
Post op dx: Renal failure on dialysis, hypertension, congestive heart failure
Procedure performed: Left radiocephalic fistula with a venogram and ligation of 4 major branches
Description of procedure: After informed consent, the patient was taken to the operating room, placed on the OR table in supine position. He had a numb left arm from a previous supraclavicular nerve block in the holding area. The left arm was prepped and draped in the usual sterile manner. 1% plain lidocaine was used to anesthetize the area and an incision was made over the cephalic vein in a curvilinear manner to expose the radial artery. The vein was exposed for about 3-4 cm. The artery was exposed for about 2.5 cm. The artery was controlled proximally and distally with Potts vessel loops. The vein was controlled proximally with a bulldog and distally with a 3-0 silk tie. The vein mobilized easily to the artery. The patient was given a total of 4000 units of heparin and we allowed it 4 minutes circulation time. The artery was then controlled proximally and distally with Potts vessel loops. A venogram was obtained that showed multiple branches. A glow until marking tape radiopaque was used to isolate the branches and mark each of the branches for ligature. There were 4 branches to be ligated. The vein was then mobilized easily to the artery. The artery was opened longitudinally with a #11 blade and Potts scissors. The anastomosis was performed by opening the vein with Potts scissors for 4.5 cm and the anastomosis was performed with a 6-0 Surgipro running simple stitch in a heel-to-toe manner. All the clamps were removed. There were 2 bleeding points that required independent sutures to control the bleeding points in the anastomosis, but otherwise it was fully hemostatic. The branches had been previously marked during the venogram. A separate incision was made over these 4 major branches. Each of the branches were isolated, ligated on each side, and divided. The fistula has a good pulse, thrill and bruit. It lies in a nice gentle curve at the end of the procedure. All each of the incisions were closed with 3-0 Polysorb running stitch in the deep layer, and 4-0 Caprosyn running subcuticular stitch for the skin. Benzoin, Steri-Strips, and dry sterile dressings were applied.
AMA guidelines state "Also included is that portion of the operative arteriogram performed by the surgeon, as indicated."
Would venogram be the same consideration as arteriogram?
When checking my software for bundling it does not show these codes as inclusive to one another however it mentions about the AMA quidelines. This is very confusing to me.
The codes in question are 36821 and 75820.
Any help would be greatly appreciated.
Cheryl