Ask Dr. Z

LT wrist Radiobasilic transpo fully created due to concerns that the fistula would not develop it was taken down and revised to a non-transposed brachiobasilic AVF. Since the second attempt was successful and created through a separate incision would we be able to bill 36820-53 with the 36821?

Incision basilic vein to wrist. Basilic vein dissected & branches ligated/divided distally & proximately. RA was dissected. Vein was tunneled medial - lateral aspect of forearm bringing vein to RA. The vein was spatulated. Flow was established then through the fistula. The basilic vein harvest site was then closed. Noted to be no flow in the fistula. The anastomosis was then taken down and revised. Incision was made over the distal upper arm over the basilic vein made arteriotomy which was stented with Potts scissors. The vein was then spatulated using a running suture was sewn in there is a strong thrill in the fistula due to the larger size of the vein & artery. Hemostasis was confirmed. The radial artery incision and the upper arm incision were closed.