blazeunreal
Networker
I am a new Vascular coder and I am not sure how I would code this senario:
Operative Report Procedures performed: 1. left forearm exploration 2. Interposition graft with 6 mm PTFE 3. Right SCV HD catheter (16Fx 19 cm)
Pre-procedure diagnosis: Bleeding AV fistula Post-procedure diagnosis: same
This is an elderly patient with ESRD on hemodialysis via her left radiocephalic AV fistula who presented from home with pulsatile bleeding from her fistula. A blood pressure cuff was placed in the trauma bay for hemorrhage control. Operative management was discussed with patient and her spouse and consent oobtained and patient was taken urgently to the OR for definitive control.
Patient arrived in the operating room, identified by name and medical number and was placed supine on the operating table. Monitor sedation was induced. Patient right neck and left arm were prepped and draped sterrilely. Perioperative antibiotic was started. We began with making a longitudinal incision over the aneurysmal fistula. The fistula was circumferentially dissected and controlled with vessel loops. This segment of the fistula wall was thin wall with several ulcers anteriorly which were the sources of bleeding. Given the poor condition of the fistula wall a decision was made to place an interpositional graft in order to salvage the fistula. The fiistula was divided lonitudinally. A 6 mm PTFE graft was brought into field, spatulated to fit and the anastomosis was created in a standard fashion with a 6-0 Prolene. The aneurysm walls were used to cover the entire graft. Once hemostasis was satisfactory, the incision was irrigitated and closed in multiple layers and dressings placed. Following this an attempt was made to place a right IJ tunnel dialysis catheter. However, it was noted on duplex ultrasound that bilateral internal jugular veins were occluded. With that a right subclavian central catheter was utilized to exchange over an Amplatz wire and the 16F double lumen HD catheter was inserted in the standard manner. All ports were flushed with heparin saline and secured with nylon sutures.
Patient tolerated the procedures well, was awaken and taken the recovery unit in satisfactory condition. All counts were correct.
I am thinking that I would use 36556, But I am unsure about the graft and if the exploration can be coded.
Any help would be appreciated!
Operative Report Procedures performed: 1. left forearm exploration 2. Interposition graft with 6 mm PTFE 3. Right SCV HD catheter (16Fx 19 cm)
Pre-procedure diagnosis: Bleeding AV fistula Post-procedure diagnosis: same
This is an elderly patient with ESRD on hemodialysis via her left radiocephalic AV fistula who presented from home with pulsatile bleeding from her fistula. A blood pressure cuff was placed in the trauma bay for hemorrhage control. Operative management was discussed with patient and her spouse and consent oobtained and patient was taken urgently to the OR for definitive control.
Patient arrived in the operating room, identified by name and medical number and was placed supine on the operating table. Monitor sedation was induced. Patient right neck and left arm were prepped and draped sterrilely. Perioperative antibiotic was started. We began with making a longitudinal incision over the aneurysmal fistula. The fistula was circumferentially dissected and controlled with vessel loops. This segment of the fistula wall was thin wall with several ulcers anteriorly which were the sources of bleeding. Given the poor condition of the fistula wall a decision was made to place an interpositional graft in order to salvage the fistula. The fiistula was divided lonitudinally. A 6 mm PTFE graft was brought into field, spatulated to fit and the anastomosis was created in a standard fashion with a 6-0 Prolene. The aneurysm walls were used to cover the entire graft. Once hemostasis was satisfactory, the incision was irrigitated and closed in multiple layers and dressings placed. Following this an attempt was made to place a right IJ tunnel dialysis catheter. However, it was noted on duplex ultrasound that bilateral internal jugular veins were occluded. With that a right subclavian central catheter was utilized to exchange over an Amplatz wire and the 16F double lumen HD catheter was inserted in the standard manner. All ports were flushed with heparin saline and secured with nylon sutures.
Patient tolerated the procedures well, was awaken and taken the recovery unit in satisfactory condition. All counts were correct.
I am thinking that I would use 36556, But I am unsure about the graft and if the exploration can be coded.
Any help would be appreciated!