Ask Dr. Z

Micropuncture needle was used to cannulate arterial stump of fistula, and then arteriogram was performed of left forearm. The patient had previous arteriogram earlier that day. I injected dye into the arm with the fistula clamped, but to my dismay got a similar picture as radiology. The dye was sluggishly passed through forearm vessels with the ulnar artery being dominant. The radial and ulnar arteries were carefully dissected out and controlled with vessel loops. The brachial artery was then controlled with a vessel loop. Transverse incision was made in the brachial artery, and a Fogarty catheter was advanced into the radial artery and ulnar artery. Unfortunately I could not pass catheter or extract clot. I injected tPA into ulnar artery, opened radial artery, let tPA out, and then completed arteriotomy closure. The fistula was clamped during this whole time." I'm not sure what code to use since the tPA was not injected in the actual fistula and was not left overnight: 37211 vs. 36904?