The patient presented with an enlarged aneurysmal area near the anastomosis to the brachial artery. Since she is post-renal transplant and is no longer on dialysis, a decision was made to also excise the fistula.
What is the code for the excision of the aneurysm, takedown of the fistula and primary repair of the left brachial artery? Would these procedures be included in CPT code 35236, Repair blood vessel with vein graft; upper extremity, as described in Coding Clinic for HCPCS, 4th Quarter, 2011, Pages 7–8?
A “takedown” of the arteriovenous (AV) fistula implies ligation of the AV fistula and arterial repair. Based on the documentation submitted with your request, the arteriovenous fistula was ligated and the aneurysmal area was near the anastomosis; therefore, it would be appropriate to report CPT code 37607, Ligation or banding of angioaccess arteriovenous fistula, for the procedure performed. In this case because the artery itself was not involved in the aneurysm, CPT code 35206, Repair blood vessel, direct; upper extremity, would be reported for the primary repair of the left brachial artery. If the artery were repaired with a vein patch, CPT code 35236 would be reported instead of CPT code 35206.