Ask Dr. Z

Q. My physician has "revision" of brachiocephalic fistula, but i think that this is a new creation. how would you code this? a incision was made over the course of the vein from the old scar just across the elbow. the vein was mobilized over about 4 to 5 cm. there was a large deep branch that was identified, ligated and divided. it was thought that the vein was small in that last 2cm segment and that it could be improved by making a new anastomosis to the brachial artery just above the elbow. the deep fascia was incised and the brachial artery was mobilized ovver about 2 cm. the vein was ligated and divided distally. the pt was given 3,000 units of heparin intravenously. the artery was clamped and opened obliquely. an end-to-side anastomosis was fashioned with running prolene. the clamps were released and there was an excellent thrill. the vein was somehat thick and it was thought large clips would be too big for the smaller size artery. the incision was closed.