Ask Dr. Z

"Our patient had an infected chronic thrombus and aneurysm in her left upper extremity AV fistula. She was taken to the OR for excision. A duplex Doppler was used to measure the brachial artery flow and to check the outflow vein to decide on the area of disconnection and division. Images were retained. The fistula was excised by disconnecting it from the brachial artery, followed by anastomosis and repair of the brachial artery. The aneurysm, chronic thrombus, and overlying skin were excised in the needle access segment of the fistula. The cut end of the outflow vein was repaired at the level of the shoulder. The 6 x 4 cm skin defect was closed with flaps." Can any imaging be billed? How do we code for the excision of the fistula?