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Distal revascularization and interval ligation (DRIL) is a surgical procedure performed to address complications arising from hemodialysis access, specifically in cases of steal syndrome. Steal syndrome occurs when the blood flow intended for the hand is diverted due to the presence of a hemodialysis access site, leading to ischemia, which is a deficiency of blood supply, and resulting in symptoms such as hand pain. The primary goal of the DRIL procedure is to restore adequate blood flow to the hand by creating a bypass around the hemodialysis access site. This is achieved by placing a bypass graft in the arm, with one end of the graft connected to the artery above the hemodialysis access site (proximal anastomosis) and the other end connected to the artery below the access site (distal anastomosis). The procedure involves making incisions in the upper and lower arms to access the brachial artery, which is the main artery supplying blood to the arm. The surgical steps include exposing the artery, creating a subcutaneous tunnel for the graft, harvesting a vein graft (often from the saphenous vein in the leg), and performing anastomoses to connect the graft to the brachial artery. Additionally, the procedure includes ligating a segment of the brachial artery to prevent retrograde blood flow into the hemodialysis access, thereby ensuring improved perfusion to the hand. The success of the procedure is confirmed by checking blood flow through the graft and evaluating distal pulses to ensure the bypass graft remains patent.
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The distal revascularization and interval ligation (DRIL) procedure is indicated for patients experiencing complications related to hemodialysis access, specifically those diagnosed with steal syndrome. The following conditions warrant the performance of this procedure:
The DRIL procedure involves several critical steps to ensure successful revascularization of the upper extremity. Each step is designed to restore adequate blood flow to the hand while addressing the complications associated with hemodialysis access.
Post-procedure care following the DRIL surgery includes monitoring the patient for any signs of complications, such as bleeding or infection at the incision sites. Patients are typically advised to keep the surgical area clean and dry, and follow-up appointments are scheduled to assess the patency of the bypass graft and the overall blood flow to the hand. Additionally, the healthcare team may perform Doppler studies to evaluate blood flow and ensure that the graft is functioning as intended. Patients may also receive instructions on activity restrictions to promote healing and prevent strain on the surgical site.
| Short Descr | DIST REVAS LIGATION HEMO | Medium Descr | DSTL REVSC&INTERVAL LIG UXTR HEMO ACCESS | Long Descr | Distal revascularization and interval ligation (DRIL), upper extremity hemodialysis access (steal syndrome) | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P6C - Minor procedures - other (Medicare fee schedule) | MUE | 1 | CCS Clinical Classification | 63 - Other non-OR therapeutic cardiovascular procedures |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | AG | Primary physician | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) |
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| 2011-01-01 | Changed | Short description changed. |
| 2004-01-01 | Added | First appearance in code book in 2004. |
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