Ask Dr. Z

Please help; I'm very confused. I would like to know what codes to use for a left AV fistulogram with central venous angioplasty and left brachiocephalic arteriovenous fistula, surgical revision with flow reducing tapered plication of the AV anastomosis. "Patient with left upper arm brachiocephalic arteriovenous fistula with excessive pressure due to presumed venous stenosis and additional excessive arterial inflow. 54-year-old gentleman with longstanding history of end-stage renal disease on hemodialysis. He dialyzes via a left upper arm brachiocephalic arteriovenous fistula. He has undergone previous repair of an apparent bleeding pseudoaneurysm at an outside facility, but continues to have problems with dramatically swollen left upper extremity and wound breakdown at the previous surgical site. He comes to the operating room at this time for further evaluation and treatment as able."