Radiology Coding Alert

Get the official word on what makes 75791 different from 36147.

CPT® can pack a lot into one little code. Here's a closer look at just what "arteriovenous shunt created for dialysis [graft/fistula]" means in 36147.

The code: The code in focus here and in "36147 Features Official Includes/Excludes Rules in 2012," on page 27, is 36147 (Introduction of needle and/or catheter, arteriovenous shunt created for dialysis [graft/fistula]; initial access with complete radiological evaluation of dialysis access, including fluoroscopy, image documentation and report [includes access of shunt, injection(s) of contrast, and all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava]).

You'll typically use 36147 when a patient with end-stage renal disease (ESRD) is having trouble with his AV shunt for dialysis and requires an evaluation.

AV shunt defined: "For diagnostic studies, the arteriovenous (AV) dialysis shunt (AV shunt) is defined as beginning with the arterial anastomosis [opening between two normally separate structures] and extending to the right atrium. This definition includes all upper and lower extremity AV shunts (arteriovenous fistulae [AVF] and arteriovenous grafts [AVG])," CPT® guidelines state.

An AVF for dialysis is surgically created by cutting an opening in an artery and an opening in a nearby vein and then joining the openings together so that blood can communicate between the artery and the vein (see Figure 1). An AVG also involves creating openings in an artery and a vein, but uses an artificial vessel to link the two openings (see Figure 2).

Contrast with +36148, 75791: CPT® Assistant (March 2010) reminds you that you have two additional codes to consider for AV shunt services. Report +36148 (...additional access for therapeutic intervention [List separately in addition to code for primary procedure]) in addition to 36147 if the initial evaluation (36147) prompts a therapeutic intervention requiring a second shunt catheterization.

Remember that you don't use +36148 to identify a second diagnostic injection procedure from a second access point. Use +36148 when an interventional procedure is provided from that second access point.

If percutaneous access had already been established prior to the service, 36147 would not be appropriate. You should instead report 75791 (Angiography, arteriovenous shunt [e.g., dialysis patient fistula/graft], complete evaluation of dialysis access, including fluoroscopy, image documentation and report [includes injections of contrast and all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava], radiological supervision and interpretation).