Ask Dr. Z

Our coders are struggling to agree on how to code this procedure. We cannot come to an agreement of the best suited codes to use. "Patient has left brachiocephalic fistula that has two aneurysms that developed two ulcerations. Physician performed incisions in vertical fashion, excising the aneurysm and excessive skin on two aneurysmatic area, one above the antecubital area and the other in the distal upper arm. Incision taken down to the dilated aneurysmatic vein. Vein entered, skin and ulcer were excised in both lesions. Aneurysmatic vein wall then excised so about 1 cm of conduit on each incision. Closed venotomies on each incision. Clamp released for flow thru fistula. Then punctured access in mid upper arm, placed sheath, obtained shuntogram which showed the cephalic arch had a stent and vein was present. Superior vena cava was patent but innominate vein 80% stenosed. Angioplasty performed; sheath removed site closed."