Deciphering Dialysis Circuit Coding for Advanced Comprehension

Navigating the intricate landscape of medical coding demands a comprehensive understanding of the nuances within the codes and their applications. With IR remaining vastly complex, our experts agree that when it comes to the area of dialysis circuit procedures, precise code selection is paramount for accurate billing and compliance. This month, we break through the barriers surrounding codes 36901 through 36905, shedding light on their distinct purposes, limitations, and proper utilization. By delving into the intricacies of each code and providing practical insights, professionals can be empowered to effectively capture the intricacies of dialysis circuit interventions.

Gaining an Understanding of Guidance

CPT® offers a range of acceptable code options reflecting procedures conducted within the dialysis circuit, typically involving direct access to the circuit. During a single session, only one code from 36901–36906 can be billed. Additionally, codes 36907–36909 serve as add-ons and should be reported alongside one of the codes from 36901–36906 when applicable. However, in this blog please note only 36901 through 36905 will be analyzed, but coders should be aware of the entire coding family.

36901

Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography of the dialysis circuit, including all direct puncture(s) 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;

Code 36901 is designated for direct access into the dialysis circuit specifically for diagnostic imaging purposes, without subsequent therapeutic intervention in the peripheral segment during the same session. It’s important not to code 36901 alongside 36902, 36903, 36904, 36905, or 36906. Moreover, 36901 can be reported for diagnostic imaging of the dialysis circuit in conjunction with procedures outlined in codes 36907–36908.

The code encompasses one or more accesses into the dialysis graft/fistula and imaging of the entire dialysis graft circuit from the arterial anastomosis through the central veins. If the catheter must be maneuvered up to and into the vena cava or across the arterial anastomosis to better visualize the graft, those catheterizations are included in 36901. Understand that code 36901 also includes catheterization and imaging  of venous side branches when necessary.

Knowing when to report or not report a modifier. When performing a dialysis fistulagram without further intervention within the peripheral segment of the dialysis circuit, it is necessary to report code 36901 with modifier 52 if the fistulagram is accomplished by injection of contrast into an existing access.

36902

Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography  of the dialysis circuit, including all direct puncture(s) 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; with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty

When should 36902 be reported over 36901 or the other family of codes? Report code 36902 when diagnostic angiography of the dialysis circuit is performed along with angioplasty within the peripheral segment  Many scenarios may present themselves where multiple lesions are treated, and it may be tempting to report this code multiple times. However, Code 36902 may be reported only once, no matter how many lesions are treated. This code includes angioplasty of the arterial peri-anastomotic area. What circumstances should this code not be reported?

• Do not report angioplasty codes 37246–37249 for angioplasties within the dialysis circuit.
• Do not report 36901 in addition to 36902.
• Do not report 36902 for balloon removal of the arterial plug, see code 36904 instead.

36903 Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography

of the dialysis circuit, including all direct puncture(s) 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; 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

Report code 36903 for diagnostic imaging of the dialysis circuit plus stent placement in the peripheral segment. Angioplasty, if performed, is included and not separately reported, even when separate lesions are treated.  Code 36903 should only be billed once regardless of the number of stents placed within the peripheral segment. Be aware you should not report codes 36901 and/or 36902 along with 36903.

36904

Percutaneous transluminal mechanical thrombectomy and/or infusion for 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);

Code 36904 encompasses diagnostic imaging along with mechanical thrombectomy and/or thrombolytic infusion within the dialysis circuit. It covers thrombectomy and/or infusion in both peripheral and central segments. This code includes various techniques such as lyse-and-wait, employment of mechanical devices like:

• Trerotola®
• thrombus suction
• arterial plug removal
• intra-graft thrombolysis,
•  and balloon maceration of thrombus.

 It’s worth noting that this code is applicable in situations where the procedure is performed within or outside of the dialysis graft circuit, as specified by its definition allowing for “any method” of execution. Do not report codes 36901, 36902, or 36903 along with 36904.

36905

Percutaneous transluminal mechanical thrombectomy and/or infusion for 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); with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty

Report code 36905 for mechanical thrombectomy/thrombolytic infusion within any portion of the dialysis circuit plus angioplasty within the peripheral segment. This code also includes diagnostic fistulagram. Do not report 36901, 36902, 36903, or 36904 with 36905. Do not report 36905 if stent placement is also performed in the peripheral segment along with thrombectomy/thrombolysis, see code 36906 instead. Note that the code definition specifies this procedure may be performed by “any method”; therefore, this code is utilized in both situations when access for the procedure is either within or outside of the dialysis graft circuit.

These are NOT all the tips and tricks necessary to tackle dialysis circuit coding.

As service volumes rebound and every dollar of reimbursement counts more than ever in the face of payment cuts, it’s imperative to make sure your CPT® coding is correct and compliant. Master more IR coding topics and break down the complexity with our expert-infused 2024 Diagnostic and Therapeutic Dialysis Shunt Interventional Radiology Coding webcast live on March 13, 2024, or on-demand past this date. This webcast is an essential training tool for both audio and visual learners.