2025 CPT code 36833
(Active) Effective Date: N/A Revision 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
Open revision of an arteriovenous fistula with thrombectomy; autogenous or nonautogenous dialysis graft (separate procedure).
Modifier 59 (Distinct procedural service) may be necessary if 36833 is performed with an unrelated procedure.
Medical necessity is established when a patient experiences decreased or absent blood flow through an AV fistula or graft, necessitating surgical intervention to restore adequate hemodialysis access. Documentation must support the clinical indication for the procedure.
The surgeon performs the open surgical revision of the arteriovenous fistula, including incision, dissection, clamping of vessels, thrombectomy, repair or replacement of the graft, flushing, and wound closure.
- 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 surgically opens and repairs a connection between an artery and a vein (fistula) used for dialysis, removing any blood clots that are blocking blood flow.They may use a new graft to repair the fistula.
This CPT code describes the open surgical revision of an arteriovenous (AV) fistula, which includes the removal of a thrombus (blood clot) from the connection between the artery and vein.The procedure involves accessing the fistula, removing the clot, repairing any damage to the fistula connection, and potentially using a new graft to restore functionality. The procedure is considered a separate procedure and may require modifier 59 if performed with an unrelated procedure.
Example 1: A patient with an established autogenous AV fistula for hemodialysis presents with decreased blood flow.The surgeon performs an open revision of the fistula, removes a significant thrombus, and repairs the connection between the artery and vein., A patient with a nonautogenous AV graft experiences thrombosis. The surgeon performs a thrombectomy and repairs the graft using a new segment of graft material., A patient requires revision of a previously created AV fistula due to stenosis and recurrent thrombosis. The surgeon performs an open revision with thrombectomy and repairs the stenosis and the damaged fistula.
* Preoperative assessment including fistula location, type of graft, and indication for revision.* Intraoperative findings, including the size and location of the thrombus, the extent of fistula damage, and the type of repair performed.* Postoperative assessment including assessment of blood flow, healing of the incision, and the patient's response to the procedure.* Images such as ultrasound or arteriogram to document the status before and after the procedure.
** This procedure is typically performed under general or regional anesthesia.The choice of graft material (autogenous or nonautogenous) will influence the coding and documentation.
- Revenue Code: P2F (MAJOR PROCEDURE, CARDIOVASCULAR - OTHER)
- RVU: Data not available in source.Consult current fee schedules and local payers for RVU and reimbursement information.
- Global Days: Data not available in source.The global period will vary depending on payer and local policies.Consult your payer's guidelines.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Fee Schedule: Data not available in source.Consult historical fee schedules from CMS and other payers for historical data.
- Specialties:Vascular Surgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center, Outpatient Hospital