Hemodialysis
There are two new pages of green explanatory information under the new heading: Dialysis Circuit with several definitions:
Dialysis circuit: The arteriovenous (AV) dialysis circuit is designed for easy and repetitive access to perform hemodialysis. It begins at the arterial anastomosis and extends to the right atrium. The circuit may be created using either an arterial-venous anastomosis, known as an arteriovenous fistula (AVF), or a prosthetic graft placed between an artery and vein, known as an arteriovenous graft (AVG). The dialysis circuit is comprised to two segments, termed the (1) peripheral dialysis segment and (2) central dialysis segment. Both are defined below.
Peripheral dialysis segment: 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. This segment includes the historic “peri-anastomotic region” (defined below).
Peri-anastomotic region: A historic term referring 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.
Central dialysis segment: includes all draining veins central to the peripheral dialysis segment. In the upper extremity, the central 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 segment includes the veins central to the common femoral vein, including the external iliac and common iliac veins through the inferior vena cava.
The documentation should include the segment of the dialysis circuit in which the procedure is being performed.
| 36901 | Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography of the dialysis circuit, including all direct punctures) 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; |
| 36902 | with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty |
| 36903 | with transcatheter placement of intravascular stent(s), peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the stenting, and all angioplasty within the peripheral dialysis segment |
| 36904 | Percutaneous transluminal mechanical thrombectomy and/or infusion of thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance. Catheter placement(s). and intraprocedural pharmacological thrombolytic injection(s); |
| 36905 | with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty |
| 36906 | with transcatheter placement of intravascular stent(s), peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the stenting, and all angioplasty within the peripheral dialysis circuit |
| 39607+ | with transluminal balloon angioplasty, central dialysis segment, performed through dialysis circuit, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty (list separately in addition to code for primary procedure) |
| 36908+ | Transcatheter placement of intravascular stent(s), central dialysis segment, performed through dialysis circuit, including all imaging radiological supervision and interpretation required to perform the stenting, and all angioplasty within the central dialysis segment (list separately in addition to code for primary procedure) |
| 36909+ | Dialysis circuit permanent vascular embolization or occlusion (including main circuit or any accessory veins), endovascular, including all imaging and radiological supervision and interpretation necessary to complete the intervention (list separately in addition to code for primary procedure) |
Current Procedural Terminology (CPT) is copyright 2017 American Medical Association. All rights reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no other health insurance liability for the data contained herein.