Ask Dr. Z

I have a challenging AV fistula case, and I want to ensure I credit my surgeon with the work involved. The case begins with a cutdown over the fistula. He attempts thrombectomy but says it is unsuccessful (not retrieving much clot and still poor thrill). He then shoots a fistulogram, identifies a high grade stenosis in the venous outflow, and angioplasties. He then sees contrast flowing out of the vein on fluoro and decides to stent the area to try to salvage things, but that doesn't resolve the problem. He ultimately decides he cannot salvage the fistula and ligates it completely. Are we prevented from trying to capture the stent (36903) with 37607 since this is one fistula and it is no longer patent when the case is finished? I'm leaning towards 37607 with modifier -22 plus 36901 for the imaging but it seems insufficient.