Ask Dr. Z

"Transverse incision made, cephalic vein dissected free and ligated. Next aponeurosis of the bicep tendon is open and the brachial artery controlled with vessel loop, arteriotomy performed and vein ligated. Circumferential anastomosis with 6-0 prolene completed." I feel this should be billed with code 36821, but the physician feels this is code 36818. We have had payers deny stating that a subcutaneous tunnel of the vein must be performed in order to bill code 36818. What truly constitutes the transposition of a vein since tunneling and/or two sites do not always have to be done during 36818?