The AMA created nine new codes for hemodialysis access maintenance. The three for transluminal balloon angioplasty (36907–36909) were already introduced in a previous email.
These codes bundle the surgical aspects of the service with the radiological supervision and interpretation.
There are:
- 6 base codes that include diagnostic angiography when performed (36901–36906);
- 2 add-on codes for central venous intervention when approach is direct puncture of the dialysis access (36907, 36908); and
- 1 add-on code for embolization (36909).
The following codes were deleted as a result: 36147, +36148, 36870, and 75791.
36901 – Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava, fluoroscopic guidance, radiological supervision and interpretation and image documentation and report;
36902 – with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty
36903 – with transcatheter placement of intravascular stent(s), peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the stenting, and all angioplasty within the peripheral dialysis segment
36904 – Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural pharmacological thrombolytic injection(s);
36905 – with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty
36906 – with transcatheter placement of intravascular stent(s), peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the stenting, and all angioplasty within the peripheral dialysis circuit
Only one code from 36901–36906 is reported per encounter. These codes include:
- All punctures and catheterizations of the dialysis access/circuit;
- Closure of the puncture by any method;
- All angiography, fluoroscopic image guidance, road mapping, and radiological supervision and interpretation required;
- Removal of the arterial plug in a dialysis access thrombectomy; and
- Interventions in the peri-anastomic segment.
These codes do not include:
- Moderate sedation;
- Ultrasound guidance for puncture;
- IVUS;
- Diagnostic arteriography of the extremity that includes more than the perianastomotic segment; and
- Selective catheterization of the artery from a direct puncture of the fistula.
Append modifier 52 to CPT 36901 if the diagnostic study is performed from access other than direct puncture of the fistula. In this case the catheterization would be reported separately.