Ask Dr. Z

Please do NOT include any actual patient medical records with your question. I have a question about a internal reposition of a PICC line done during an AV fistulogram. The patient has a right forearm radial artery to cephalic vein fistula. The fistula is punctured, imaging done. Catheter is advanced across the right innominate vein, SVC, into the left innominate and subclavian vein and venogram done of the left arm to look at the possibility of creating an AV shunt on this side. Here is the part of the procedure I am questioning:..."The vertebral glide catheter was removed. We then partially inflated the 9 x 4 P3 balloon at the coil in the PICC line and gently pulled the balloon back in order to resolve the coil. The coil flipped as the balloon passed across this area and we then used the balloon to drag the tip back into the lower SVC. Postprocedure imaging showed the coil to be completely resolved and the PICC line tip was in the low SVC." Should I use 36597 for this reposition or the unlisted vascular 37799? Any guidance from you is appreciated. Thank you.