carriebeth
Networker
I coded 36147 37205 75960. my doctor believes there should also be a 35476 75978
HISTORY: The patient presents with continued difficulty with cannulation, particularly with the venous needle. Last angioplasty was only 3 weeks ago. On physical exam, the fistula has areas of infiltration around the venous cannulation site. The fistula begins to dive deep and medially in this area. He saw Dr. ______ with these problems who recommended repeat fistulogram with probable stent placement and if this does not work, he might need repeat surgery.
EXAM: Left upper arm fistulogram with venous angioplasty and stent placement
PREOP DIAGNOSIS: Difficult cannulation AV fistula
POSTOP DIAGNOSIS: Venous stenosis, AV fistula
PROCEDURE: After informed consent and under sterile conditions the left upper arm native brachiobasilic fistula was accessed in the venous direction and fistulogram was performed to the SVC. There was 50% stenosis at the swing site within the main outflow of the fistula which is tortuous as it dives deep and medially. The central veins were patent without stenosis. Next, a 10 mm by 80 mm Fluency (gortex covered) stent was placed across the stenosis and then the lesion was dilated to full effacement with a 10 mm balloon. Follow-up fistulagram showed no residual stenosis at the swing site with rapid flow. The previously tortuous segment is now completely straight. The catheter was then removed and hemostasis was easily obtained. IMPRESSION: The left arm fistula was treated with angioplasty and stent placement. He has limited cannulation sites, so it is likely the stent will need to be cannulated with the venous needle. This is okay and in fact may provide easier cannulation. Please do not develop a buttonhole for the venous needle due to the presence of the stent. The stent site was marked on his skin with a permanent marker and a diagram is attached to this report. The inflow artery is from a radial artery with a high takeoff from the brachial artery.
HISTORY: The patient presents with continued difficulty with cannulation, particularly with the venous needle. Last angioplasty was only 3 weeks ago. On physical exam, the fistula has areas of infiltration around the venous cannulation site. The fistula begins to dive deep and medially in this area. He saw Dr. ______ with these problems who recommended repeat fistulogram with probable stent placement and if this does not work, he might need repeat surgery.
EXAM: Left upper arm fistulogram with venous angioplasty and stent placement
PREOP DIAGNOSIS: Difficult cannulation AV fistula
POSTOP DIAGNOSIS: Venous stenosis, AV fistula
PROCEDURE: After informed consent and under sterile conditions the left upper arm native brachiobasilic fistula was accessed in the venous direction and fistulogram was performed to the SVC. There was 50% stenosis at the swing site within the main outflow of the fistula which is tortuous as it dives deep and medially. The central veins were patent without stenosis. Next, a 10 mm by 80 mm Fluency (gortex covered) stent was placed across the stenosis and then the lesion was dilated to full effacement with a 10 mm balloon. Follow-up fistulagram showed no residual stenosis at the swing site with rapid flow. The previously tortuous segment is now completely straight. The catheter was then removed and hemostasis was easily obtained. IMPRESSION: The left arm fistula was treated with angioplasty and stent placement. He has limited cannulation sites, so it is likely the stent will need to be cannulated with the venous needle. This is okay and in fact may provide easier cannulation. Please do not develop a buttonhole for the venous needle due to the presence of the stent. The stent site was marked on his skin with a permanent marker and a diagram is attached to this report. The inflow artery is from a radial artery with a high takeoff from the brachial artery.
