Ask Dr. Z

Please advise if code 36832 is appropriate for the following scenario: "The patient has a functioning brachiocephalic fistula and presents for excision of a severely aneurysmal radiocephalic fistula. The radial artery proximal and distal to the anastomosis was dissected out and controlled with vessel loop. The radial artery proximal to the fistula was noted to be severely dilated. The excision was extended along the length of the fistula to the antecubital fossa, and the aneurysmal radiocephalic fistula was exposed. The fistula was then dissected out to free up its adhesions to the overlying subcutaneous tissue. There were multiple branches that were hypertrophied and were suture ligated. The cephalic vein was amputated at the antecubital fossa and oversewn proximally. The aneurysmal fistula was then freed up from underlying adhesions all the way to the wrist. There were multiple crossing veins, which were hypertrophied and required ligation. The aneurysmal anastomosis was taken down, and the radial artery was ligated."