Basics of AV Fistula CPT code

AV fistula CPT codes are bundled. These bundled codes include all the minor procedure used for performing interventional procedure on AV. Arteriovenous (AV) shunt or fistula are created for vascular access sites which is required for hemodialysis. The AV fistula are direct artery to vein anastomosis and in AV grafts a prosthetic material is used a loop or connection to an artery (proximally) and vein (distally). AV fistula can be placed in upper arm or forearm, thigh or chest. So, the CPT code 36901 is the main procedure code, used for taking access in AV fistula.

The previously used codes (36147, 36148, 36870, 75791, 35476, 75798, 35475, 75962) have been deleted and are no longer in use.

Code 36901 describes a traditional diagnostic fistulagram with assessment of the circuit from arterial anastomosis through the vena cava. All needle placements, as well as nonselective catheter manipulations within the circuit, are included in the code and are not separately reportable. If the catheter is advanced to the vena cava, code 36010 is not additionally reported. Additionally, angiography in arm access of the superior vena cava (75827) and in leg access of the inferior vena cava (75825) is bundled. If ultrasound guidance is required for access into the vessel, this is separately reported with 76937.

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Description of CPT code 36901

The CPT code description of 39601 includes all the minor procedures. This code includes all the contrast injection, Radiological Supervision and Interpretation (RS&I) used while taking access or direct puncture in the AV fistula. Below is the detail description of CPT code 36901.

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

Now, as per the description CPT code 36901 includes all the contrast injection, RS&I and imaging of the entire dialysis circuit, including the adjacent inflow artery (peri-anastomotic region), arterial anastomosis, shunt, and venous outflow up to and including the complete superior or inferior vena cava. The CPT code 75791 (deleted in 2017) which used to describe  the radiological supervision and interpretation only for a complete evaluation of an arteriovenous dialysis fistula or graft, will no more exist.

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Definition of Central Dialysis Segment

Before using CPT code 36901 for fistulogram, we have to know the important definitions of Central dialysis segment, Peripheral dialysis segment and Peri-anastomotic region.

Central dialysis segment includes all draining veins central to the peripheral dialysis segment. In the upper extremity, the central dialysis segment includes the veins central to the axillary and cephalic veins, including the subclavian and innominate veins through the superior vena cava. In the lower extremity, the central dialysis segment includes the veins central to the common femoral vein, including the external iliac and common iliac veins through the inferior vena cava. Other named or unnamed veins may be included in this segment.

Peripheral dialysis segment is the portion of the dialysis circuit that begins at the arterial anastomosis and extends to the central dialysis segment. In the upper extremity, the peripheral dialysis segment extends through the axillary vein (or entire cephalic vein in the case of cephalic venous outflow). In the lower extremity, the peripheral dialysis segment extends through the common femoral vein. 

Peri-anastomotic region refers to the region of a dialysis circuit near the arterial anastomosis encompassing a short segment of the parent artery, the anastomosis, and a short segment of the dialysis circuit immediately adjacent to the anastomosis and is included within the peripheral segment of the dialysis circuit.

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When to code CPT code 36901

For the initial access in AV fistula or graft or the direct puncture, CPT code 36901 should be used.

Do not report CPT code 36901 more than once for access and evaluation of an AV graft or shunt. 

For a single or multiple access into the shunt, code 36901 should be reported once only to describe the access and imaging for the diagnostic study.

All the Additional access without intervention in AV fistula are included in CPT code 36901.

Earlier we used CPT code 36148 (deleted in 2017) for addition access in AV fistula with intervention. But, from 2017 all the additional access in AV fistula with intervention like angioplasty, stent etc. will be reported with CPT code 36902-36909.

When only the diagnostic angiography of the fistula or dialysis circuit is performed via a remote or existing access, we have to use 52 modifier along with CPT code 36901.  For hospital billing we will use 74 modifier with 36901.

We need to report separately the selective catheter placement CPT codes when imaging is performed through remote access.

All the access sites into the AV fistula or graft for diagnostic shuntogram and/or intervention are bundled with codes 36901-36909.

Codes 36901-36906 include all the necessary catheter placement and manipulation to perform a graft/fistula diagnostic radiological study; however, 36215 (selective catheter placement, arterial system; each first order thoracic or brachiocephalic branch, within a vascular family) is not inherent to the work of 36901-36906. When a catheter is maneuvered from a puncture of the dialysis graft/fistula into the proximal inflow vessel for formal extremity diagnostic arteriography, code 36215 is reported in addition to 36901-36906. Reporting 36215 to position the catheter tip simply at or near the arterial anastomosis of the arteriovenous access is not appropriate. If such an inflow catheterization is performed with extremity arterial angiography as well as arteriovenous access imaging, report one of the base codes (36901-36906) in addition to 36215 and the unilateral extremity arterial imaging code 75710.

RVU and Fees for CPT code 36901

Supply and Equipment codes used with CPT code 36901

SA016 kit, guidewire introducer (Micro-Stick)
SA019 kit, iv starter
SA048 pack, minimum multi-specialty visit
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
SC058 syringe w-needle, OSHA compliant (SafetyGlide)
SD136 vascular sheath
SD171 guidewire bowl w-lid, sterile
SD172 guidewire, cerebral (Bentson)
SF007 blade, surgical (Bard-Parker)
SG009 applicator, sponge-tipped
SG055 gauze, sterile 4in x 4in
SG079 tape, surgical paper 1in (Micropore)
SG095 Hemostatic patch
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)

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

Additional Code Information for CPT code 36901

PC/TC Indicator (26):0 = Physician Service Codes
Multiple Procedures (51):2 = Standard payment adjustment rules for multiple procedures apply
Bilateral Surgery (50):0 = 150% payment adjustment for bilateral procedures does not apply
Physician Supervision:09 = Concept does not apply
Assistant Surgeon (80,82):1 = Statutory payment restriction for assistants at surgery applies to this procedure
Co-Surgeons (62):0 = Co-surgeons not permitted for this procedure
Team Surgery (66):0 = Team surgeons not permitted for this procedure
Diagnostic Imaging Family:99 = Concept does not apply