Ask Dr. Z

One of our physicians created a right posterior tibial artery to tibial vein graft for plastic surgery free flap using the GSV. The patient had a large open traumatic wound of the right lower extremity requiring reconstructive surgery with a large free flap. We were asked to created a graft to provide inflow and outflow to the flap. The documentation is pretty clear; he harvests the GSV and does an anastomosis to the tibial artery and tibial vein when he was done there was excellent thrill in the graft. I have requested to bill an unlisted code for the procedure to my QM department. They have said no, that I should bill 36825. I disagree... that code is for renal disease, which is not the case here. I believe an unlisted code with the appropriate dx code for the wound is how this procedure should be billed. What would your recommendation be? If you think it is appropriate to bill 36825 I will go with that.