I am a little confused on this surgery. I am not sure if this is the correct coding. 36221, 36216-xs, 75710, 36225, 75774x2
Findings:
1. Patent arch without flow stenosis and patent R Brachiocephalic artery, L CCA and L SCA without flow limitations or signficant plaque
2. Patent L SCA, AxA, brachial, ulnar and radial artery
3. Palmar arch is intact with noted steal from radiocephalic AVF
4. Improved flow noted on occlusion of the cephalic vein
Operative Report:
The patient and family were met in holding and the risks and complications of the procedure were discussed with them to include but not limited to pain, bleeding infection, requiring further surgeries or procedures, injury to the common femoral artery, dissection, embolization, retroperitoneal bleed, open repair of access artery, require amputation, heart attack, stroke and death. The patient was taken to the cath lab and underwent sedation. The patient was then prepped and draped in the usual sterile fashion. A time out was performed confirming the procedure laterality and perioperative antibiotics.
An ultrasound was used to identify the right common femoral artery and a micropuncture was used to gain access into the vessel and the wire placed within the lumen. Fluoroscopy was used to confirm needle position and placement, the needle was then exchanged for the dilator and the inner cannula and wire were removed. We then placed a glide wire into the aorta and exchanged for a 5 Fr short sheath. We placed a pigtail catheter into the aortic arch and angled the Gantry to LAO to remove any parallax. The patient was then heparinized. We performed an arch angiogram with the above findings. We then used an angled glide wire and angled glide catheter to access the left SCA and performed an angiogram from the proximal SCA. We used the wire to advance the catheter into the axillary artery and performed an angiogram from the axillary artery and then advanced the catheter into the brachial artery to complete our imaging. We noted with the above findings.
Findings:
1. Patent arch without flow stenosis and patent R Brachiocephalic artery, L CCA and L SCA without flow limitations or signficant plaque
2. Patent L SCA, AxA, brachial, ulnar and radial artery
3. Palmar arch is intact with noted steal from radiocephalic AVF
4. Improved flow noted on occlusion of the cephalic vein
Operative Report:
The patient and family were met in holding and the risks and complications of the procedure were discussed with them to include but not limited to pain, bleeding infection, requiring further surgeries or procedures, injury to the common femoral artery, dissection, embolization, retroperitoneal bleed, open repair of access artery, require amputation, heart attack, stroke and death. The patient was taken to the cath lab and underwent sedation. The patient was then prepped and draped in the usual sterile fashion. A time out was performed confirming the procedure laterality and perioperative antibiotics.
An ultrasound was used to identify the right common femoral artery and a micropuncture was used to gain access into the vessel and the wire placed within the lumen. Fluoroscopy was used to confirm needle position and placement, the needle was then exchanged for the dilator and the inner cannula and wire were removed. We then placed a glide wire into the aorta and exchanged for a 5 Fr short sheath. We placed a pigtail catheter into the aortic arch and angled the Gantry to LAO to remove any parallax. The patient was then heparinized. We performed an arch angiogram with the above findings. We then used an angled glide wire and angled glide catheter to access the left SCA and performed an angiogram from the proximal SCA. We used the wire to advance the catheter into the axillary artery and performed an angiogram from the axillary artery and then advanced the catheter into the brachial artery to complete our imaging. We noted with the above findings.
