Ask Dr. Z

Would this be just one code 36832, or would a second or unlisted code be used for lipectomy? 

"1. Revision of right AV fistula by way of side branch ligation.

2. Subcutaneous fatty tissue excision overlying cephalic vein and forearm for vein superficialization.

PROCEDURE: After team timeout and performed sterile mapping with ultrasound of the fistula, found a large side branch coursing laterally marked this position. We also marked several positions along the forearm 4 counterincisions versus lipectomy of subcutaneous fat to bring the skin closer to the fistula. After team timeout, we performed a small incision overlying the side branch and ligated this with 3-0 silk sutures x2. We then turned our attention to the lipectomy with 2 transverse incision across and performed cylindrical removal of fatty tissue overlying the vein, we also lysed the vein fascia that was keeping it in place in the forearm, superficializing this and had a nasal groove of palpable cephalic vein afterwards. We had excellent hemostasis."