2025 CPT code 36832
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on Arteries and Veins Surgery Feed
Open revision of an arteriovenous fistula without thrombectomy; autogenous or nonautogenous dialysis graft.
Modifiers may be applicable depending on the circumstances. Modifier 59 (Distinct Procedural Service) may be necessary if performed with other unrelated procedures.
Medical necessity is established by documentation of inadequate blood flow through the AV fistula impacting hemodialysis access, requiring surgical intervention to restore functionality.Pre- and post-operative assessments of blood flow should be documented.
The surgeon's responsibilities include prepping and anesthetizing the patient, making incisions, dissecting the fistula, clamping blood vessels, repairing the graft or using a new graft, flushing the graft, removing clamps to restore blood flow, and suturing the incision.
- Surgery
- Hemodialysis Access, Intervascular Cannulation for Extracorporeal Circulation, or Shunt Insertion Procedures on Arteries and Veins
In simple words: This code describes a surgery to fix a connection between an artery and a vein used for dialysis. The surgeon opens the connection, repairs it, and may replace part of it.This doesn't include removing a blood clot.
This CPT code encompasses the open surgical revision of an arteriovenous (AV) fistula, either autogenous or nonautogenous, used for hemodialysis access.The procedure involves surgically opening the fistula, repairing the connection between the artery and vein, and potentially using a new graft.A thrombectomy (removal of a blood clot) is not included. The procedure is performed when the fistula malfunctions and requires repair, but no clot needs removal.
Example 1: A 60-year-old male with end-stage renal disease and an autogenous AV fistula experiences a stenosis at the anastomosis, leading to reduced blood flow.Open revision of the fistula is performed without thrombectomy to restore adequate blood flow for dialysis., A 55-year-old female with a nonautogenous AV fistula develops a narrowing at the venous outflow, compromising dialysis access.An open revision of the fistula is performed to widen the area and improve flow, without needing to remove any blood clots., A 72-year-old patient with an AV fistula created months ago presents with decreased flow and compromised dialysis access.The surgeon performs an open surgical revision. The fistula is opened, the anastomosis inspected and repaired, with no evidence of thrombosis requiring thrombectomy.
Detailed operative report specifying the type of fistula (autogenous or nonautogenous), location of the fistula, description of the surgical repair, whether a graft was used, and confirmation of no thrombectomy performed.
** Accurate documentation is crucial for proper coding and reimbursement.The absence of a thrombectomy is a key differentiating factor between this code and other related codes (36831 and 36833).
- Revenue Code: P2F (Major Procedure, Cardiovascular - Other)
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Specialties:Vascular Surgery, General Surgery, Nephrology
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center, Hospital Outpatient