General Surgery Coding Alert

Question: Surgeons in our practice sometimes create vascular access by arteriovenous fistula or anastomosis for patients who will receive hemodialysis. Please describe these procedures to help me understand when I should use 36821 or 36825 for the service.

California Subscriber

Answer: Code 36821 (Arteriovenous anastomosis, open; direct, any site (eg, Cimino type) (separate procedure)) describes a procedure in which the surgeon creates an arteriovenous anastomosis by connecting a vein to an artery in any site. Surgeons perform the procedure to provide better vascular access in a patient with kidney failure who will receive hemodialysis treatments. You may see this procedure referred to as a Cimino-type anastomosis.

On the other hand, code 36825 (Creation of arteriovenous fistula by other than direct arteriovenous anastomosis (separate procedure); autogenous graft) describes a procedure in which the surgeon surgically creates an arteriovenous fistula. An AV fistula is a connection between an artery and a vein using an autogenous vein graft from a donor patient, which is a direct, end-to-end anastomosis graft. Surgeons may also perform this service to allow for hemodialysis treatments.

Distinction: You should report 36825 when the surgeon uses material taken from a donor patient for the anastomosis. This is different from direct arteriovenous anastomosis code 36821, because the surgeon uses an autogenous vein graft, as opposed to a cannula insertion.

Restrictions: Because the 36825 descriptor indicates that this 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).

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