Ask Dr. Z

"Patient has 2 aneurysms in the prox aspect of his AV fistula. He had multiple venograms by an outside interventionalist & review of notes indicates a moderate stenosis just distal to aneurysm that has been ballooned multiple times...aneurysms were excluded using Ioban. A small transverse counter incision was made over the prox aspect of the arterialized cephalic vein & circumferentially dissected. Having achieved proximal control, we created another counter incision just approx 2cm distal to the distal fistula. This is to exclude both fistulae & area of stenosis. We then tunneled an Accuseal graft & created an end-to-end anastomosis with the graft & the prox arterialized cephalic vein. We then made an end-to-end anastomosis between the graft & the distal cephalic vein. Central venogram was performed with PTA of cephalic arch for 50% stenosis) We then turned to aneurysms. 2 elliptical incisions over the apices of the aneurysms are created & the aneurysms are circumferentially dissected & ligated at both ends & removed." What should I charge for this case?