Ask Dr. Z

We have an ESRD patient who ran out of dialysis access options. Two surgeons worked on her. Physician #1 (thoracic surgeon) did an incision of RT anterior chest wall, entered pleural space, excised pericardial fat pad, incised pericardium and dissected the RT atrial appendage free from aorta & SVC. Physician #2 (vascular surgeon) created a tunnel across anterior chest wall, brachial artery was fragile & injured requiring a bovine patch. He then made an arteriotomy on the patch & anastamosed a Goretex graft to the ptach and tunneled the graft across the anterior chest wall. Next the other end of the graft was anastamosed to atrial appendage by Physician #1. Chest tube was place in the RT pleural space and attached to Pleur-Evac suction. There are three billers involved in the coding. One biller states it can't be an AV dialysis graft, as no vein is involved. However, the RT atrium is acting as the venous anastomosis, according to the vascular surgeon. How would you code this case? We are considering codes 36830-22 and 32551, but we really are out of our comfort zones.