Cardiology Coding Alert

Question: What is the difference between 36821 and 36825, and can they be billed with 36901?

California Subscriber

Coding expertise for this issue provided by Christina Neighbors, MA, CPC, CCC, Coding Quality Auditor for Conifer Health Solutions, Coding Quality & Education Department, and member of AAPC’s Certified Cardiology Coder steering committee.

Answer: With 36821 (Arteriovenous anastomosis, open; direct, any site (eg, Cimino type) (separate procedure)), the surgeon creates an arteriovenous anastomosis, by connecting a vein to an artery in any site to provide better vascular access in a patient with kidney failure who will receive hemodialysis treatments. It is also known as a Cimino type anastomosis.

For 36825 (Creation of arteriovenous fistula by other than direct arteriovenous anastomosis (separate procedure); autogenous graft), the surgeon surgically creates an arteriovenous fistula, a connection between an artery and a vein using an autogenous vein graft (direct end-to-end anastomosis graft) from a donor patient. This service is done to allow for hemodialysis treatments.

Also, since the descriptor for 36825 indicates that it is a separate procedure, the surgeon cannot report this code separately when he performs the service in an anatomically-related region through the same skin incision. However, if the provider performs 36825 with an unrelated procedure, you may need to append modifier 59 (Distinct procedural service).

You would report 36825 when a provider creates the arteriovenous graft he uses for anastomosis from material taken from a donor patient. Use of this code is different from direct arteriovenous anastomosis because it is using an autogenous vein graft, as opposed to a cannula insertion.

Don’t miss: CPT^® instructions under 36825 tell you to use 36821 for direct arteriovenous anastomosis.

If open dialysis circuit creation, revision, and/or thrombectomy (codes 36818-36833) are performed, then completion angiography is bundled, as is peripheral segment angioplasty and/or stent placement (codes 36901, 36902, or 36903) and, therefore, are not separately reported, according to the CPT^® manual.

However, dialysis circuit central segment angioplasty and/or stent placement may be separately reported (codes +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)) and +36908 (Transcatheter placement of intravascular stent(s), central dialysis segment, performed through dialysis circuit, including all imaging and radiological supervision and interpretation required to perform the stenting, and all angioplasty in the central dialysis segment …).