Ask Dr. Z

"A 5 French micropuncture sheath was advanced into the cephalic vein, followed by an exchange to a 7 French Pinnacle sheath. Next a 5 French puncture sheath was placed into the reverse saphenous vein graft and the patient’s DRIL bypass. Initially the arterial anatomy was scrutinized: widely patent anastomoses of DRIL graft. Axillary and brachial arteries were moderately calcific but patent. Then a venogram of the cephalic vein was performed: critical stenosis of the LT subclavian vein just distal to its subclavian and innominate confluence. This finding is consistent with venous TOS. Through the sheath, a glidewire with a 5 French Kumpe catheter traversed the tandem venous stenoses. A superior venacavagram was performed. Next, serial venoplasty with Armada 8 x 40 cm balloon, followed by ConQuest 10 x 40 cm balloon, was performed. Post venogram revealed widely patent venous segments." Here are our coding thoughts: DRIL access (36120, 75710-26), venacavagram with venous access (36005, 75820-26), venoplasty (35476, 75978-26). Provider is asking for fistulogram. Is the DRIL part of AV fistula?