2025 CPT code 36821
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Surgery - Hemodialysis Access, Intervascular Cannulation for Extracorporeal Circulation, or Shunt Insertion Procedures on Arteries and Veins Surgical Procedures on the Cardiovascular System Feed
Creation of an arteriovenous anastomosis by directly connecting a vein to an artery, typically for hemodialysis access.
Modifiers such as 22 (Increased Procedural Services), 50 (Bilateral Procedure), 51 (Multiple Procedures), 52 (Reduced Services), 59 (Distinct Procedural Service), and 76 (Repeat Procedure by Same Physician) may be applicable depending on the specific circumstances of the procedure.
Medical necessity for 36821 is established by the patient's need for hemodialysis access due to end-stage renal disease or chronic kidney disease.Documentation must demonstrate the lack of suitable alternative access sites and the clinical need for surgical creation of the arteriovenous anastomosis to ensure adequate hemodialysis.
The vascular surgeon or other qualified physician is responsible for performing the procedure, including pre-operative assessment, surgical creation of the anastomosis, hemostasis, and wound closure. Post-operative care may be shared with other healthcare professionals.
- Surgical Procedures on the Cardiovascular System
- Surgical Procedures on the Cardiovascular System > Hemodialysis Access, Intervascular Cannulation for Extracorporeal Circulation, or Shunt Insertion Procedures on Arteries and Veins
In simple words: The doctor creates a connection between an artery and a vein to make it easier for a dialysis machine to clean the blood during hemodialysis. This is often done for people with kidney failure.
This CPT code, 36821, describes an open surgical procedure where a direct arteriovenous (AV) anastomosis is created by connecting a vein to an artery at any suitable site.The procedure is commonly performed to establish vascular access for hemodialysis in patients with kidney failure.The anastomosis is created without the use of a graft or synthetic material, representing a direct connection between the vessels.A common example is the Cimino-type anastomosis, connecting the cephalic vein to the radial artery at the wrist. The procedure aims to increase blood flow through the vein, facilitating efficient hemodialysis.
Example 1: A patient with end-stage renal disease requiring hemodialysis undergoes creation of a Cimino-type arteriovenous fistula using the cephalic vein and radial artery., A patient with chronic kidney disease requires an arteriovenous anastomosis in the forearm for hemodialysis access. The surgeon creates a direct connection between a suitable vein and artery., A patient with ESRD needs a new access site for hemodialysis due to thrombosis of a previously created AV fistula. A direct AV anastomosis is surgically created in the upper arm using the basilic vein and brachial artery.
Complete medical history, including renal function tests;Pre-operative vascular studies (ultrasound, angiography); Operative report detailing the technique, location of anastomosis, and any complications; Post-operative assessment of patency and function of the AV anastomosis.
** Always ensure accurate and complete documentation to support the medical necessity and proper coding of this procedure.Consult with a coding specialist if any uncertainties exist about appropriate code selection and modifier usage.
- Revenue Code: P2F (MAJOR PROCEDURE, CARDIOVASCULAR - OTHER)
- RVU: This information is not provided in the source data and would need to be obtained from a current fee schedule or relative value unit database.
- Global Days: Information regarding the global surgical period for this code is not provided in the sources.
- Payment Status: Active
- Modifier TC rule: The information provided does not specify if a Technical Component (TC) modifier applies to this code.Consult current coding guidelines.
- Fee Schedule: Fee schedule data is not included in the source data.Consult a historical fee schedule database for specific information.
- Specialties:Vascular Surgery, Nephrology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center