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Help . what is the correct CPT 36818 or 36832
Procedure: Left brachiocephalic fistula
After witnessed informed consent was obtained the patient was brought to the operating room and placed in the supine position. Block anesthesia was administered and found to be adequate. The Left arm was prepped and draped in a sterile fashion. After injection of local anesthesia, the incision was made and carried through the superficial fascia. The cephalic vein was exposed and tributaries were ligated with 4-0 silk ties and divided. The cephalic vein was circumferentially mobilized. It was marked anteriorly with a surgical marker to ensure no twisting of the vein.
Moving to the brachial artery, it was fully mobilized and its branches were ligated and divided to assist in elevating the artery above the fascial layer. It was noted to be of good caliper.
The vein was divided and its transected end was irrigated with a heparin solution to allow for gentle mechanical dilatation of the vein.
The artery was occluded with vascular clamps and an arteriotomy was made.
An end of vein to side of the artery anastomosis was created with 6-0 prolene suture in a parachute technique.
The distal arterial clamp was removed and inspection of the suture line for bleeding was made. The proximal arterial clamp was removed. Hemostasis was obtained.
The course of the outflow vein was checked to remove any fascial bands and to assure that there were no kinks or twists.
Wound closure was accomplished with 3-0 Vicryl in the superficial fascia and 4-0 Vicryl in the skin. A gauze and Tegaderm dressing was applied.
The patient was transferred to the Post Anesthesia Care Unit in good condition.
Procedure: Left brachiocephalic fistula
After witnessed informed consent was obtained the patient was brought to the operating room and placed in the supine position. Block anesthesia was administered and found to be adequate. The Left arm was prepped and draped in a sterile fashion. After injection of local anesthesia, the incision was made and carried through the superficial fascia. The cephalic vein was exposed and tributaries were ligated with 4-0 silk ties and divided. The cephalic vein was circumferentially mobilized. It was marked anteriorly with a surgical marker to ensure no twisting of the vein.
Moving to the brachial artery, it was fully mobilized and its branches were ligated and divided to assist in elevating the artery above the fascial layer. It was noted to be of good caliper.
The vein was divided and its transected end was irrigated with a heparin solution to allow for gentle mechanical dilatation of the vein.
The artery was occluded with vascular clamps and an arteriotomy was made.
An end of vein to side of the artery anastomosis was created with 6-0 prolene suture in a parachute technique.
The distal arterial clamp was removed and inspection of the suture line for bleeding was made. The proximal arterial clamp was removed. Hemostasis was obtained.
The course of the outflow vein was checked to remove any fascial bands and to assure that there were no kinks or twists.
Wound closure was accomplished with 3-0 Vicryl in the superficial fascia and 4-0 Vicryl in the skin. A gauze and Tegaderm dressing was applied.
The patient was transferred to the Post Anesthesia Care Unit in good condition.