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AV Fistula revision or new graft creation

Date: Jun 25, 2021

Question:

I believe this is a revision of AV fistula (36832) with perhaps a -22 modifier appended; however, the surgeon wants to use 35011 and 36830. What are your thoughts?

"Indication for Surgery: Left forearm cephalic vein aneurysm, ESRD, degenerated left forearm AV fistula aneurysm. Surgical Procedure: Excision of aneurysmal left forearm cephalic vein, placement of a left forearm PTFE AV graft. Procedure: A long elliptical was incision made along forearm cephalic vein that was aneurysmal; it incorporated the degenerated overlying skin as a long skin paddle. Cephalic vein was dissected free, clamped, and divided. Aneurysmal segment of cephalic vein was handed off as specimen. I then anesthetized a lateral curvilinear tunnel and passed a PTFE graft through the tunnel and created a beveled end-to-end anastomosis between the graft and the inflow cephalic vein at the wrist. The graft had a strong inflow pulse. Excess graft was trimmed and created an end-to-end anastomosis to the outflow cephalic vein at the proximal forearm. Graft had a strong thrill."

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