Janice Posted Mon 18th of December, 2017 15:18:59 PM
36830-59 ???? thanks
..the patient was given a nerve block. She was sedated. She was prepped and draped in a sterile fashion. An incision was made in the axilla. The axillary vein was dissected for a good portion of length and proximal and distal control was obtained. We then got out the brachial artery through an incision at the antecubital fossa and gave heparin. We used a Gore hybrid graft, so we clamped the distal axillary vein and held digital manual pressure over the proximal axillary vein. I made a small longitudinal venotomy. We then inserted the distal end of the hybrid graft, which was a Viabahn stent graft into the venotomy and we advanced it until only 10 cm of the graft was visible on the outside. We deployed the graft and took our clamps off and flushed it and made sure there was good backbleeding from the vein. We then used a Gore tunneler to tunnel the graft from the venotomy site down to the brachial artery and made sure that there were no kinks and that it was in good anatomic position. We made an arteriotomy with 11 blade scalpel of the brachial artery after we clamped proximally and distally. We extended that with Potts scissors. We sewed the graft end-to-side to the artery with a running 6-0 Prolene suture with 6 anastomosis and good thrill of the graft. We made sure that there was good hemostasis. There was preserved pulses in the hand. We reversed heparin with protamine, and closed in 3 layers. The patient tolerated the procedure well.
SuperCoder Answered Tue 19th of December, 2017 23:54:09 PM
Cpt given above seems appropriate as per the documentation. Please check for CCI edit with other billable CPT codes for modifier 59.
Hope this helps!