Ask Dr. Z

Does code 36147 include selective venography of a collateral vein to assess for surgical turndown option? Or should I use codes 75791, 36011? "Patient has left upper brachial artery to cephalic vein fistula. Lower fistula is punctured and contrast injected, demonstrating decent flow through the fistula which is well-dilated peripherally. There is one focal area of mild narrowing in the mid fistula which is not felt to be flow limiting. There is diffuse stenosis of the cephalic arch with collateral vessels draining to the axillosubclavian veins. Left-sided central veins are widely patent, as is SVC. Next a glidewire is advanced centrally and a sheath placed. A glide catheter was used to selectively catheterize the left arm basilic vein. Diagnostic venogram was performed at the same time that the fistula imaging was performed to assess the feasibility of surgical turndown option. This showed the basilic vein to be a large caliber vessel comparable in diameter to the fistula. It was widely patent through its transition to the axillosubclavian vein."