Ask Dr. Z

Dr Z. I have a question reqarding attempted recanalization of occluded fistula. The patients left upper cephalic vein was punctured just beyond the AV fistula and peripheral to a large thrombosed aneurysm. Multiple attempts were made in an effort to advance out of the thrombosed aneurysm into the outflow cephalic vein in previously stented segment but this was not possible. Ultrasound demonstrates that the aneurysm is thrombosed and that the cephalic vein is thrombosed to the central cehpalic vein. The previously placed stent is thrombosed. In light of the very large aneurysm and the inability to cross out of it, it was felt that the fitula is not salvageable. I'm questioning whether this can be consider a actual fistulagram since the aneurysm prevented him from entering the fistula. Can you help with coding this? Your comments would be greatly appreciated. d :)