PROCEDURES PERFORMED:
1. Right forearm fistulogram.
2. Right peripheral venous angioplasty.
3. Right radial artery balloon angioplasty with catheter introduction x2.
INDICATIONS FOR THE PROCEDURE: This 83-year-old male is well known to me. I have been managing his access for many years. We were notified that his fistula had become thrombotic; however, on examination, there seemed to be areas of stenoses within the fistula and some reduced inflows, but there was no evidence of thrombus.
PROCEDURE IN DETAIL: The patient was taken to the XXX and sterilely prepped and draped in standard fashion. After infiltration with 1% lidocaine, a needle, a wire, and a short 6-French sheath were inserted in the direction of the antecubital fossa. Aliquots of diluted Visipaque were utilized to visualize the fistula, and there seemed to be a 95% stenosis approximately measuring 3 cm medial to the antecubital fossa. A 6 mm balloon was passed across this lesion, and upon insufflating the lesion, a reflux study was done which showed arterial narrowing across the initial arterial segment of 85% to 90%. Following insufflation in the venous end, a second sheath was passed in the direction of the wrist. A 5 mm balloon was passed across this lesion, and serial insufflations were performed here as well. The completion study showed markedly improved flow. Catheters and wires and sheaths were removed. Pressure was held to the exit site until hemostasis was achieved. The patient tolerated the procedure well. He seemed to have a good quality thrill and bruit in the recovery area. All counts were verified.
Physician coded this as follows:
36147
36148
35475-59
35476-59
75962-59
75978-59
all codes were paid except 35475 & 35476, which seems to be a pattern with a lot of our claims---help!!!
1. Right forearm fistulogram.
2. Right peripheral venous angioplasty.
3. Right radial artery balloon angioplasty with catheter introduction x2.
INDICATIONS FOR THE PROCEDURE: This 83-year-old male is well known to me. I have been managing his access for many years. We were notified that his fistula had become thrombotic; however, on examination, there seemed to be areas of stenoses within the fistula and some reduced inflows, but there was no evidence of thrombus.
PROCEDURE IN DETAIL: The patient was taken to the XXX and sterilely prepped and draped in standard fashion. After infiltration with 1% lidocaine, a needle, a wire, and a short 6-French sheath were inserted in the direction of the antecubital fossa. Aliquots of diluted Visipaque were utilized to visualize the fistula, and there seemed to be a 95% stenosis approximately measuring 3 cm medial to the antecubital fossa. A 6 mm balloon was passed across this lesion, and upon insufflating the lesion, a reflux study was done which showed arterial narrowing across the initial arterial segment of 85% to 90%. Following insufflation in the venous end, a second sheath was passed in the direction of the wrist. A 5 mm balloon was passed across this lesion, and serial insufflations were performed here as well. The completion study showed markedly improved flow. Catheters and wires and sheaths were removed. Pressure was held to the exit site until hemostasis was achieved. The patient tolerated the procedure well. He seemed to have a good quality thrill and bruit in the recovery area. All counts were verified.
Physician coded this as follows:
36147
36148
35475-59
35476-59
75962-59
75978-59
all codes were paid except 35475 & 35476, which seems to be a pattern with a lot of our claims---help!!!