Ask Dr. Z

"Venogram was done through existing intravenous catheter of right upper extremity prior to creation of AVF. Incision was made in right wrist with dissection of cephalic vein of adequate caliber. Through the same incision the radial artery was dissected and arteriotomy performed; however, poor arterial inflow was identified so the procedure was discontinued. Arteriotomy was repaired and skin incision closed. Skin incision was made in antecubital fossa after ultrasound was used to identify the basilic and brachial arteries. Dissection of both basilic vein and brachial artery was performed. Brachial arteriotomy was made and basilic vein clipped with an end-to-side anastamosis completed." Would the initial discontinued procedure be billable with a -53 modifier since it is a separate incision, or would only the completed AVF be billable with the venogram?