I am looking for some guidance on a coding issue. This doesn't seem to be specifically addressed in the coding manual. This particular case began with a pateint with falling access flows a fistulagram was ordered and revealed an outflow occlusion in the primary outflow brachial vein. The access was kept open via a communicator to the brachial vein.
I was able to get across the the occlusion ultimately, and we were able to re-cannulate the access.
This case required multiple wires adn guiding catheters to cross the occlusion and multiple balloons, and finally a stent and anticoagulation the re-cannulte the access. Clearly there are more resources, time and risk involved than fistulagram.
Does anyone have experience with the most appropriate codes to use? Is this best coded as a thrombectomy, thrombectomy-in-situ, or just a PTA?