Ask Dr. Z

Dr's I'm totally in the dark on how to complete the coding this one. The patient has a malfunctioning upper arm brachiocephalic fistula with in-stent stenosis of the proximal cephalic vein and recurrent stenosis of the distal cephalic vein. Selective catheterization of the fistula with fistulagram was performed and then Silver Hawk atherectomy of recurrent stenosis within the cephalic venous stent, proximal vein followed by balloon angioplasty of the recurrent stenosis, distal cephalic vein. I coded 35476/75978/36147 for the balloon angioplasty of the distal cephalic vein, but frankly I am at a loss for how to code the atherectomy of the proximal cephalic portion of the fistula. 0237T atherectomy of brachiocephalic trunk doesn't seem correct. Would I use an unlisted code? Any advice would be greatly appreciated.