Ask Dr. Z

Patient with brachiocephalic AVF has a crushed stent in the subclavian vein, which is causing issue with outflow. The physician performed a bypass of the subclavian vein by placing a PTFE graft from the cephalic vein at the level of the shoulder to the internal jugular vein. The AV fistula venous anastomosis was not recreated or altered in any way. Would the below be considered a revision of the AV fistula (36832) or a vein-to-vein bypass (37799)? 

"The dorsal surface of the cephalic vein was incised with a #15 blade scalpel, and this was extended proximally and distally with Potts scissors. The 8 mm PTFE graft was spatulated. We performed an end-to-side anastomosis with 5-0 prolene suture. We turned our attention to the distal anastomosis within the internal jugular vein. Again, a #15 blade scalpel was used to incise the skin. The jugular vein was exposed and skeletonized. A venotomy was performed to construct an end-to-side anastomosis. The bypass graft was again spatulated in order to fit the venotomy."