Ask Dr. Z

We have a case where the patient had a synthetic AV graft. "Dr. X removed the graft and performed thrombectomy and angioplasty of stenosis to re-establish flow, but due to poor pulsation they harvested the basilic vein and performed an interposition graft. They then created a new direct AV graft, but due to the fact that they found it had poor flow, they tied off the fistula in order to divert all blood flow to the upper extremity." All this was performed during the same operative session. We're looking at code 35236 for the repair and code 37607 for tying off of the newly created AV fistula, but it seems like we're missing something. Since the AV fistula was created and left in (albeit ligated) at the end of the procedure, can we report those codes? And the thrombectomy and angioplasty performed prior to the interposition graft, do we lose those codes because it wasn't successful and therefore the doctor decided to perform the interposition graft and created a new AV graft at a different location instead of replacing the AV graft that was there?