Ask Dr. Z

The patient came in for removal of a malfunctioning peritoneal dialysis catheter and creation of a fistula. The catheter was removed. Then creation of a fistula was attempted. From the op report: "We made a transverse incision over the antecubital fossa and dissected down. The cephalic vein was dissected free and ligated at the perforators. Attempts to flush the vein noted is to be under high pressure. I passed a vessel dilator without success and attempted to pass a 4 mm balloon which caused injury to the vein requiring ligation. We attempted to dilate the vein towards the wrist without success. At this point there was no possibility of fistula and the wound was closed with a 3-0 and then 4-0 Monocryl. We will need to reassess his venous system and possibly perform an upper arm graft. I need to discuss this with the patient prior to proceeding." How should the attempted fistula be coded?