Ask Dr. Z

Patient has a functional LUE AV fistula and non-functional aneurysmal RUE AV fistula, causing pain - no infection. The physician decides to remove the RUE cephalic vein.

"We started with dissecting the cephalic vein down to the brachiocephalic anastomosis. The cephalic vein was noted to be extremely calcified and aneurysmal as it was transected close to the brachiocephalic anastomosis. An extensive endarterectomy had to be carried out including the brachial artery, requiring three sutures distally to tack down the distal endpoint. We were then able to close the cephalic vein close to the brachiocephalic anastomosis, closing the arterial venous anastomosis over the brachial artery. The suture line was in the cephalic vein, close to the brachiocephalic anastomosis, and endo venectomy had been carried out here too. We continued to excise the rest of the cephalic vein along the entire length of the arm, to the shoulder with, extensive mobilization."

Is this a revision 36832 or partial excision 37799? Is the brachial artery endarterectomy separately reportable?