Table of Contents

Basics of CPT code 36902, 36903, 36904, 36905, 36906

Today we will learn about CPT codes for angioplasty, stent and thrombectomy which includes diagnostic angiography and RS&I like other existing angioplasty procedure codes. CPT code 36902, 36903, 36904, 36905, 36906 and the add-on CPT code +36907, +36908, +36909, these codes have bundled lot of minor procedures like catheter placement, radiological S&I, contrast injection etc. So, let us check more about these CPT codes in details

This post will help to get more knowledge about coding complex percutaneous procedure. Having a good knowledge of a ICD 10 and CPT codes will make you prepare for CPC and Certified coding specialist (CCS) exam in future.

Coding description of code 36902, 36903, 36904, 36905, 36906

For CPT code 39902 and 36903, the physician inserts a needle or catheter into a dialysis circuit via a puncture in the skin overlying the circuit of a dialysis patient. The catheter is guided into the circuit and vessel to an area upstream of the site under investigation, and contrast material is injected into it. Report 36901 for the initial access, including shunt access, contrast injections, and all fluoroscopic imaging deemed necessary from the arterial anastomosis and adjacent artery through the entire venous outflow (inferior and superior vena cava included).

For CPT code 36902, a catheter with a balloon attached is inserted into the peripheral dialysis segment and fed into the narrowed portion where its balloon may be inflated several times in order to stretch the diameter, allowing a more normal flow of blood through the area. For CPT code 36903, a catheter with a stent-transporting tip is threaded over the guidewire into the peripheral dialysis segment and the wire is extracted. The catheter travels to the point where the vessel needs additional support. The compressed stent is passed from the catheter into the vessel, where it deploys, expanding to support the vessel walls. Once the procedure is complete, the catheter is removed and pressure is applied over the puncture site

36902 – 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; with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty

36903 -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; 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

For CPT code 36904, the physician treats the dialysis circuit occlusion with mechanical thrombectomy and/or thrombolysis infusion. The devices used for mechanical thrombectomy include those that fragment the thrombus with or without removal of the clot, as well as those that come into contact with the vessel wall. The dialysis circuit is cannulated to gain access and 5,000 units of heparin are administered. Angiography is performed to confirm the occluded segment. A hydrophilic wire is passed across the occlusion, followed by passing of the Trellis device over a stiff exchange length wire. The distal and proximal balloons are inflated in the segment on either side of a treatment zone containing infusion to isolate the treatment zone and to sustain the fluid concentration that is infused.

One milligram of tissue plasminogen activator (TPA) is infused into the treatment zone. The Turbo Trellis is run at 4,000 rpm for five minutes. After the proximal balloon is deflated, small clots are removed via the integral aspiration port to prevent embolization. Thrombolysis infusion may be performed with a catheter threaded over the wire for pharmaceutical administration directly within the thrombosis. When the procedure is complete, the instruments are removed and pressure is applied over the puncture site to stop the bleeding. This procedure is reported with 36904 and includes imaging guidance, diagnostic angiography, catheter placement, and intraprocedural pharmacological thrombolytic injections.

CPT code 36905 is reported when the peripheral dialysis segment is treated with balloon angioplasty. A catheter with a balloon attached is inserted into the segment and fed into the narrowed portion, where its balloon may be inflated several times in order to stretch the diameter allowing a more normal flow of blood through the area.

CPT code 36906 is reported when the peripheral dialysis segment is treated with an intravascular stent. A catheter with a stent-transporting tip is threaded over the guidewire into the vessel and the wire is extracted. The catheter travels to the point where the vessel needs additional support. The compressed stent is passed from the catheter into the vessel, where it deploys, expanding to support the vessel walls. Once the procedure is complete, the catheter is removed and pressure is applied over the puncture site.

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 -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); with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty

36906 – 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); 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

For CPT code 36907 and 36908, the physician inserts a needle or catheter into a dialysis circuit via a puncture in the skin. The catheter is guided into the circuit to an area upstream of the investigation site and contrast material is injected. In CPT code 36907, a catheter with a balloon attached is inserted into the central dialysis segment and fed into the narrowed portion, where its balloon may be inflated several times in order to stretch the diameter, allowing a more normal blood flow through the area. For

CPT code 36908, a catheter with a stent-transporting tip is threaded over the guidewire into the central dialysis segment and the wire is extracted. The catheter travels to the point where the vessel needs additional support. The compressed stent is passed from the catheter out into the vessel, where it deploys, expanding to support the vessel walls. Once the procedure is complete, the catheter is removed and pressure is applied over the puncture site. All imaging and radiological supervision and interpretation is included.

+36907 -Transluminal balloon angioplasty, central dialysis segment, performed through dialysis circuit, including all imaging and radiological supervision and interpretation required to perform the angioplasty (List separately in addition to code for primary procedure)

+36908 – Transcatheter placement of intravascular stent(s), central dialysis segment, performed through dialysis circuit, including all imaging radiological supervision and interpretation required to perform the stenting, and all angioplasty in the central dialysis segment (List separately in addition to code for primary procedure)

For CPT code 36909, the physician performs embolization or occlusion of a dialysis circuit (main circuit or any accessory vein) due to complications or to assist in circuit maturity and/or patency. A needle is inserted through the skin and into a blood vessel. A guidewire is threaded through the needle into the vessel. The needle is removed. A catheter is threaded into the vessel and the wire is extracted. The catheter travels to the appropriate blood vessel and beads, coils, or another vessel-blocking device are released. The beads or other device block the vessel. The catheter is removed and pressure is applied over the puncture site to stop bleeding.

+36909 – Dialysis circuit permanent vascular embolization or occlusion (including main circuit or any accessory veins), endovascular, including all imaging and radiological supervision and interpretation necessary to complete the intervention (List separately in addition to code for primary procedure)

When to use Procedure code 36902 and 36903

CPT code 36902 are used mainly for the diagnostic angiography exam of blood vessels of dialysis circuit. The dialysis circuit involves the blood vessels used for filtration of waste materials from the blood in patients with kidney failure. This code includes the angioplasty, radiological supervision and interpretation (RS&I) and should not be used more than once per operative session. CPT code 36903 has similar code description like code 36902, but is used for coding intravascular stent placement in dialysis circuit. Do not report CPT code 36902 along with 36903.

When to use CPT code 36904 and 36905

CPT code 36904 is used for coding thrombolysis in the dialysis circuit. You can use this cpt code for coding thrombolysis and/or thrombectomy in dialysis circuit. It includes all the minor procedures from inserting the catheter to the removal of blood clot from the dialysis circuit. This code includes all the angiography procedures the RS&I performed during this exam. CPT code 36905 is almost similar to code 36904 with the exception of angioplasty exam. Code 36905 includes angioplasty procedure as well along with thrombectomy and/or thrombolysis in the dialysis circuit.

When to use 36906, +36907, +36908 and +36909 CPT code

Now, CPT code 36906 is coded for the thrombectomy and/or thrombolysis in dialysis circuit along with an intravascular stent placement. This codes includes angioplasty, angiography and RS&I, which are necessary to perform stent placement and angioplasty in the dialysis circuit. Do not report CPT code 36906 along with CPT code 36901,36902, 36903 and 36904.

The remaining CPT codes +36907, +36908 and +36909 are add-on codes. These all three add-on codes can be used along with CPT code 36901-36906. But, never use these add-on codes together. CPT code 36907 and 36908 should be coded only one per angioplasty and stenting within dialysis circuit. CPT code 36909 should be reported once per encounter per day. Hence, do remember these guidelines before using these CPT codes.

If a more proximal arterial inflow problem is suspected, which is distinct from the peripheral dialysis peri-anastomotic segment, a catheter may be maneuvered from a puncture of the dialysis graft or fistula into the proximal inflow vessel for a formal extremity diagnostic arteriography; therefore, this can also be reported with code 75710.

In cases in which the proximal vasculature requires imaging, CPT code 36215, Selective catheter placement, arterial system; each first order thoracic or brachiocephalic branch, within a vascular family, may be separately reported in addition to codes 36901-36906. This reporting is appropriate for the proximal artery selective catheterization because it is not inherent to the work of codes 36901-36906. However, reporting code 36215 for placement of the catheter tip near the arterial anastomosis of the AV access is not appropriate, as that work is included in codes 36901-36906.

Similar to code 75710, code 36215 may be used to report catheter placement in patients with dialysis access, although these scenarios are not common. For example, code 36215 may be reported for image-guided retrograde catheter placement (via dialysis access) to evaluate the more proximal areas of the inflow artery up to and including the aorta, if there is no stenosis of the anastomotic or peri-anastomotic vessel. In this example, however, code 36200 is not reported in addition to code 36215 for placement of the catheter in the aorta. Code 75710 may be reported if contrast injection for diagnostic arteriography is performed through the catheter, and radiological supervision and interpretation and imaging documentation are performed. When code 75710 is reported, documentation of the medical indication for the arteriogram and a full description of the study findings must be recorded.

Supply and Equipment codes used with 36901-36909

SA015 kit, for percutaneous thrombolytic device (Trerotola)
SA016 kit, guidewire introducer (Micro-Stick)
SA019 kit, iv starter
SA048 pack, minimum multi-specialty visit
SD152 catheter, balloon, PTA
SD171 guidewire bowl w-lid, sterile
SD172 guidewire, cerebral (Bentson)
SD252 guidewire, Amplatz wire 260 cm
SF007 blade, surgical (Bard-Parker)
SF036 suture, nylon, 3-0 to 6-0, c
SG009 applicator, sponge-tipped
SG055 gauze, sterile 4in x 4in
SG079 tape, surgical paper 1in (Micropore)
SG095 Hemostatic patch
SH039 heparin 1,000 units-ml inj
SH047 lidocaine 1%-2% inj (Xylocaine)
SH065 sodium chloride 0.9% flush syringe
SH069 sodium chloride 0.9% irrigation (500-1000ml uou)
SJ088 swab, patient prep, 3.0 ml (chloraprep)
SM013 disinfectant, surface (Envirocide, Sanizide)
SM021 sanitizing cloth-wipe (patient)
SB001 cap, surgical
SB008 drape, sterile, c-arm, fluoro
SB014 drape, sterile, three-quarter sheet
SB019 drape-towel, sterile 18in x 26in
SB022 gloves, non-sterile
SB024 gloves, sterile
SB028 gown, surgical, sterile
SB033 mask, surgical
SB034 mask, surgical, with face shield
SB039 shoe covers, surgical
SB044 underpad 2ft x 3ft (Chux)
SC010 closed flush system, angiography
SC051 syringe 10-12ml
SC053 syringe 20ml
SC057 syringe 5-6ml
SC058 syringe w-needle, OSHA compliant (SafetyGlide)
SD089 guidewire, hydrophilic
SD136 vascular sheath
SD147 catheter, (Glide)
SD149 catheter, balloon inflation device

ED050 Technologist PACS workstation
EF019 stretcher chair
EF027 table, instrument, mobile
EL011 room, angiography
EQ011 ECG, 3-channel (with SpO2, NIBP, temp, resp)
EQ032 IV infusion pump