Cardiology Coding Alert

Question: I have a case where I’m not sure which CPT^® code to report. Can you help me? Using fluoroscopic guidance, the physician introduced a needle through the patient’s skin over an arteriovenous graft, serving as the dialysis access point. The physician 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 physician withdrew the needle and put pressure over the access point to control bleeding. The provider supervised the procedure, documented the images, interpreted the findings, and prepared a report.

Florida Subscriber

Answer: For this procedure, you should report 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).

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

• Advancement of the catheter to the vena cava to »provide images of that particular segment of the dialysis circuit is included in the 36901 service, 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, this is considered part of 36901, and you cannot separately report the service.
• Evaluating the peri-anastomotic portion of the »inflow is an integral part of the dialysis circuit angiogram, so it is considered a part of the 36901 service, and you cannot report it separately.

Caution: You should never report 36901 in conjunction with codes 36833 (Revision, open, arteriovenous fistula; with thrombectomy, autogenous or nonautogenous dialysis graft (separate procedure)) and dialysis circuit procedures 36902-36906.