AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS - 2021 Issue 3; Ask the Editor

Arteriovenous Fistula Revision with Graft to Cephalic Vein Stump

A patient with end-stage renal disease and a dysfunctional right brachiocephalic fistula underwent revision of the arteriovenous fistula (AVF). At surgery, the cephalic vein outflow with brachial artery anastomosis was identified and found to have an aneurysmal dilation of the vein with markedly strictured area that extended up the arm. Therefore, the decision was made to go towards the cephalic vein proximally, but this position was too small as well. The surgeon then elected to proceed with dissection of the basilic vein to be used as outflow. This vessel appeared to be adequate size and a 6 mm bovine carotid artery graft was tunneled into a very lateral position to facilitate future access to the graft. At this point, the end of the graft was anastomosed to the side of the basilic vein. Following this, the arterial anastomosis was accomplished in oblique end-to-end manner of the cephalic vein stump. Since the cephalic vein stump was used to make the arterial anastomosis and the graft was not directly anastomosed to the brachial artery, what is the appropriate ICD-10-PCS code for this procedure? ...

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