General Surgery Coding Alert

Question: Please help me understand how to code the following case: Using fluoroscopic guidance, the surgeon introduced a needle through the patient’s skin over an arteriovenous graft, serving as the dialysis access point. The surgeon then injected contrast material to visualize the circulation throughout the arterial and venous components of the entire dialysis circuit, including the superior and/or inferior vena cava. The surgeon withdrew the needle and put pressure over the access point to control bleeding. The entire procedure included documenting and interpreting images and preparing a report.

Florida Subscriber

Answer: What you’ve described is a dialysis circuit procedure. Given the steps you’ve listed, the appropriate code would be 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).

The dialysis circuit is an arteriovenous (AV) connection created for easy, repeat access for patient hemodialysis treatment. The circuit involves a peripheral and central dialysis segment, and codes for the circuit include all needle placements and nonselective catheter operations.

Coding tips: CPT^® gives you very specific guidelines about how to correctly report dialysis circuit code 36901, as follows:

• Code 36901 includes advancement of the catheter to the vena cava to provide images of that particular segment of the dialysis circuit, so you cannot separately report this procedure.
• Code 36901 includes the catheterization of additional venous side branches that communicate with the dialysis circuit. If the provider advances the catheter tip through the arterial anastomosis to provide adequate visualization, that service is also part of 36901 and you should not separately report it.
• Evaluating the peri-anastomotic portion of the inflow is an integral part of the dialysis circuit angiogram, so you should not separately report that work in addition to 36901.