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Hi! I'm hoping to get some insight on coding this procedure. Some think it could be a exploration, a repair of a vessel, or a revision.

BRIEF HISTORY: The patient is a 42-year-old gentleman who has had multiple AV access operations performed on his right arm. He presently appears to have a hybrid access with a vein to artery anastomosis but a more distal graft. He came to the hospital with this access thrombosed. He underwent percutaneous intervention for opening of the access and this was successful; however, the procedure resulted in a large hematoma in the antecubital fossa. This has been painful. It has not shown any sign of resolution. We studied it in the vascular laboratory yesterday because it was pulsatile. We did not find a false aneurysm. However, I reasoned that the hematoma had sealed or at least was causing intermittent sealing of the puncture site. Given the size of the hematoma, the patient required evacuation and exploration. He comes to the operating room at this time for this purpose. DETAILS OF PROCEDURE: The patient was brought into the operating room and placed on the table in the supine position. His right arm was placed at his side on an armboard and was prepared with ChloraPrep and sterilely draped in the usual manner. Supplemental oxygen was given. Vital signs were monitored. Sedation was induced. Timeout was performed. Operation was initiated with the infiltration of 1% lidocaine and 0.5% Marcaine solution into the skin and subcutaneous tissues of the antecubital fossa. Then, a transverse incision was made incorporating the puncture site. Incision was carried into the subcutaneous tissues. The hematoma was encountered and there was some bright red blood within the hematoma. I evacuated the hematoma and as soon as I did, I was met with pulsatile bleeding. I put my finger on the source of bleeding and then opened the incision wide enough to gain access. At the depths of the hematoma, the AV fistula had a puncture site that appeared to be about 8 French in size. Suction was held to control the stream of blood flow and the puncture was closed with 4-0 Prolene suture. Approximately 200 milliliters of blood was lost during this maneuver. Once the puncture site had been sutured, the wound was irrigated and the hematoma and walls of the false aneurysm were further evacuated. Then bleeders were controlled with electrocautery. Subcutaneous tissues were closed in 2 layers of interrupted and then running 3-0 Vicryl. Skin was closed with a running 4-0 Monocryl suture reinforced with skin sealant. A sterile compression dressing was applied. The patient tolerated the procedure well. As noted, blood loss was about 200 milliliters. No blood replacement was required.