Overcoming Dialysis Circuit Coding Challenges

Dialysis circuit coding contains a multitude of codes, each with its own nuances and rationale. CPT® gives options for code choices that are built upon a hierarchy, from procedures performed within the dialysis circuit through access directly into the circuit. Although there are several options based on the coding scenario, coders and compliance personnel must remember that only one code from 36901–36906 may be reported for the same session. While not discussed in this insight, be aware that 36907–36909 are add-on codes in this series. These add-on codes, when appropriate, must be reported with one code from the 36901–36906 series. Let’s discuss some of the main codes that comprise this series.

Breaking Down Coding for Advanced Comprehension

Code 36901 may be reported for direct access into the dialysis circuit for diagnostic imaging. However, this code is only reported for scenarios without any subsequent therapeutic intervention in the peripheral segment during the same session.

Note that you should not report 36901 with 36902, 36903, 36904, 36905, or 36906. However, 36901 may be reported for diagnostic imaging of the dialysis circuit in addition to the procedures described for add-on codes 36907–36908.

What does 36901 include? It details 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 encompasses catheterization and imaging of venous side branches, when necessary.

When a dialysis fistulagram is performed without further intervention within the peripheral segment of the dialysis circuit, report code 36901 with modifier 52, if the fistulagram is accomplished by injection of contrast into an existing access.

Code 36902 should be reported when diagnostic angiography of the dialysis circuit is performed along with angioplasty within the peripheral segment. It may be tempting to report 36902 for every lesion treated; however, this code may be reported only once, regardless of the lesion number. Code 36902 includes angioplasty of the arterial peri-anastomotic area.  Angioplasty codes (37246–37249) may not be reported for angioplasties within the dialysis circuit. Also, note that 36901 must not be reported in addition to 36902. Moreover, for balloon removal of the arterial plug, do not report 36902. In this instance, see code 36904.

Codes 36903 and 36904

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

When is 36904 reported vs 36903? Report 36904 for diagnostic imaging plus mechanical thrombectomy and/or thrombolytic infusion within the dialysis circuit. This code includes thrombectomy and/or infusion in the peripheral and/or central segments. Code 36904 includes lyse-and-wait technique, use of Trerotola® or other mechanical devices, suction of thrombus, removal of the arterial plug, intra-graft thrombolysis, and balloon maceration of thrombus.

Do not report codes 36901, 36902, or 36903 along with 36904.

These are not all the necessary coding tips and rationale essential for basic interventional radiology knowledge and dialysis circuit coding. As service volumes rebound and every dollar counts more than ever, it is imperative to make sure your CPT® coding is correct and compliant. Master more interventional radiology topics and break down the complexity with our expert-infused Diagnostic and Therapeutic Dialysis Shunt Interventional Radiology Coding webcast. This webcast is an essential training tool for both audio and visual learners.