Q: How do I code for percutaneous arteriovenous fistula (AVF) creation for hemodialysis access?
A: For the Current Procedural Terminology (CPT®) 2023 code set, new Category 1 codes were released and effective January 2023 for the creation of AVFs from an endovascular approach. These codes describe creation of an AVF in the upper extremity for hemodialysis access, via either a single access (36836) or two separate accesses (36837) to fuse a peripheral artery and peripheral vein after energy application. These codes include all associated image guidance as well as associated maturation procedures such as same-session angioplasty or competing vessel embolization.
- 36836: Percutaneous arteriovenous fistula creation, upper extremity, single access of both the peripheral artery and peripheral vein, including fistula maturation procedures (e.g., transluminal balloon angioplasty, coil embolization) when performed, including all vascular access, imaging guidance and radiologic supervision and interpretation.
- 36837: Percutaneous arteriovenous fistula creation, upper extremity, separate access sites of the peripheral artery and peripheral vein, including fistula maturation procedures (e.g., transluminal balloon angioplasty, coil embolization) when performed, including all vascular access, imaging guidance and radiologic supervision and interpretation.
Q: How do I code AVF access banding for flow reduction in the setting of access-associated steal syndrome?
A: Banding of an AVF for flow reduction is coded using the same CPT® code as complete ligation (37607). This code describes specifically ligating with suture to completely occlude the AV access or banding to reduce blood flow. This code is used regardless of approach, whether open (direct visualization of the fistula for banding) or percutaneous (needle guided suture placement under ultrasound guidance). This procedure is typically performed in the setting of steal syndrome.
Disclaimer: SIR is providing this billing and coding guide for educational and information purposes only. It is not intended to provide legal, medical or any other kind of advice. The guide is meant to be an adjunct to the American Medical Association’s (AMA’s) Current Procedural Terminology (2023/CPT®). It is not comprehensive and does not replace CPT®. Our intent is to assist physicians, business managers and coders. Therefore, a precise knowledge of the definitions of the CPT descriptors and the appropriate services associated with each code is mandatory for proper coding of physician service. Please refer to 2023 CPT® for full and complete guidelines.
Every reasonable effort has been made to ensure the accuracy of this guide; but SIR and its employees, agents, officers and directors make no representation, warranty or guarantee that the information provided is error-free or that the use of this guide will prevent differences of opinion or disputes with payers. The publication is provided “as is” without warranty of any kind, either expressed or implied, including, but not limited to, implied warranties or merchantability and fitness for a particular purpose. The company will bear no responsibility or liability for the results or consequences of the use of this manual. The ultimate responsibility for correct use of the Medicare and AMA CPT® billing coding system lies with the user. SIR assumes no liability, legal, financial or otherwise for physicians or other entities who utilize the information in this guide in a manner inconsistent with the coverage and payment policies of any payers, including but not limited to Medicare or any Medicare contractors, to which the physician or other entity has submitted claims for the reimbursement of services performed by the physician.
