10 Things You Need to Know About Dialysis Circuit Add-on Codes

The arteriovenous (AV) dialysis circuit is designed for repetitive access to perform hemodialysis. Patients on long-term dialysis will usually have an AV fistula (created by directly connecting a native vein to a native artery) or an AV graft (created by using an artificial tube attached on one end to a vein and the other end to an artery) for easy, repeated vascular access.

There is a bundled code set (36901-36909) describing procedures performed within the dialysis circuit, including three add-on codes. Here’s what you need to know for proper use of these add-on codes.

1. Codes +36907 and +36908 describe procedures performed through direct access to the dialysis circuit.
2. Codes +36907 and +36908 describe procedures performed in the CENTRAL SEGMENT ONLY.
3. If interventions are performed in the central segment from an approach OTHER THAN through the dialysis circuit, these codes are NOT assigned.
4. Like the primary codes in this series, +36907 and +36908 are built on a hierarchical scale – meaning +36908 (stenting) includes the services of and is valued higher than, +36907 (angioplasty).
5. Codes +36907 and +36908 can only be reported once, no matter how many lesions are treated in the central segment.
6. Code +36909 is specific to embolization performed in the dialysis circuit.
7. Code +36909 should be assigned when embolizing the main vessel or any/all side branches emptying into the dialysis circuit itself.
8. When selectively engaging the vessel(s) to embolize, it is not appropriate to assign any catheter placement codes with +36909.
9. Code +36909 can only be reported once per encounter, no matter how many vessels are treated.
10. None of these 3 add-on codes include diagnostic imaging, so they can be reported with 36901.