Ask Dr. Z

A question has come up regarding the correct CPT code to use for a second stage brachial vein transposition for dialysis access. Based on the CC for HCPCS directive it appears that code 36832 may be appropriate, but others are suggesting an unlisted code (37799). Could you give your thoughts? Here is the operative report (edited for space): "Procedure: Right brachial vein second stage transposition fistula...Indications: ...Right brachial vein second stage transposition fistula...Procedure in Detail: ...We divided the vein from the previous anastomosis at the antecubital region and tunneled that through the superficial tunnel in the brachial artery that was dissected free. The venogram was then performed demonstrating no evidence of kinking or twisting of the brachial vein, patent axillary vein, subclavian vein, brachiocephalic vein, and superior vena cava. An anastomosis was then performed to the brachial artery with running Prolene suture in an end-to-side fashion."