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AV fistula angioplasty for kinked vessel

Date: Dec 13, 2018

Question:

Is 36902 justified, or should we only report code 36901? Or is there another option? “A 7 mm x 2 cm angioplasty catheter was placed and the narrowings were angioplastied. No significant waist was noted suggesting that these relative narrow areas were folds or kinks in a redundant vessel rather than actual stenoses. Afterward, the fistula appears to have reasonable flow within it. Post angioplasty angiogram demonstrates mild improvement. Post angioplasty angiogram also demonstrates some spasm in the radial artery which should resolve over time. Left arm dialysis access study demonstrates a redundant section of cephalic vein in the juxta anastomotic location with relative narrow areas within it, most likely representing folding or kinking of the access. Angioplasty may have improved this area. If patient doesn't improve after procedure or if symptoms recur rapidly, consideration can be given to placing a covered stent in this region to smooth out the contour and prevent kinking. If long-term benefit from angioplasty is appreciated then repeat angioplasty."

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