AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS - 2016 Issue 3; Ask the Editor

Revision of Arteriovenous Graft

A patient with end stage renal disease (ESRD) presents with recurrent thrombosis of his left arteriovenous (AV) graft. At surgery, the polytetrafluoroethylene (PTFE) graft was dissected free at its junction with the basilic vein. The vein was opened transversely, Fogarty catheter was passed and the venous channel thrombectomized. Fistulogram was done and showed recurrent thrombosis due to intimal hyperplasia of the vein. The arm was then marked at the location of the left axillary vein for later dissection. The Fogarty catheter was passed again proximally; the clot and the PTFE graft was pulled out up to the axillary artery; the catheter was passed multiple times and heparin administered. An incision was made through the old axillary surgical scar and dissection carried down to the axillary vein. A new PTFE graft was then brought through the subcutaneous tunnel from the axillary region on down to the antecubital incision for the venous limb of the new PTFE graft, and was sewn end-to-side to the axillary vein. The old PTFE graft was then anastomosed to the new PTFE graft just above the antecubital fossa. In this case, the old graft was not removed, but was sewn to the new graft. Typically, thrombectomy is performed as part of placement of the graft. Here the thrombectomy of the basilic vein was done prior to placement of the new graft. Would the root operation be coded as “Revision” or “Bypass”? What are the appropriate ICD-10-PCS procedure codes?  ...

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