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TPA, PTA & ligation of a collateral vein of a Radiocephalic Fistula

Date: Feb 14, 2024

Question:

Pt w/radiocephalic fistula. A large collateral vein was cannulated with micropunture set. Dilator advanced in a retrograde toward the arteriovenous anastomosis. Arteriogram showed a severe stenosis of the proximal cephalic vein distal to the anastomosis. PTA of the stenosis was performed. In order to treat the thrombus within the access TPA was instilled within the access. The thrombus was also macerated percutaneously. Prior to the completion of the procedure a 2-1 Vicryl suture was inserted through the skin & subcutaneous tissue surrounding the collateral vein. The suture was tied so that the flow through the vein was disrupted. Findings: A critical stenosis of the proximal cephalic vein was dilated with 5mm balloon with improvement in caliber. A small volume of thrombus within the fistula at the level of the antecubital fossa was treated with TPA as well as maceration of the clot. The large competing collateral vein was ligated using 2-1 Vicryl. Would the codes be 36000 (access), 36905 (Fistula TPA & PTA) and 36909 (vein ligated)?

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