2025 CPT code 36902
(Active) Effective Date: N/A Revision Date: N/A Surgery - Vascular Procedures Surgery Feed
Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography and transluminal balloon angioplasty of the peripheral dialysis segment.
Modifiers 22, 51, 52, 53, 58, 59, 73, 74, 76, 77, 78, 79, 99 may be applicable depending on the specific circumstances of the procedure. Refer to the most recent CPT guidelines for modifier use.
Medical necessity for 36902 is established when diagnostic angiography reveals hemodynamically significant stenosis (narrowing) in the peripheral segment of a dialysis access (AVF or AVG) resulting in compromised hemodialysis access.Documentation must support the clinical need for intervention to maintain or restore adequate blood flow for successful dialysis.
The physician is responsible for pre-procedure preparation, anesthesia administration (if applicable), fluoroscopic guidance, catheterization, contrast injection, balloon angioplasty, post-procedure hemostasis, radiological supervision, image interpretation, and report generation.This may include collaboration with other healthcare professionals such as radiology technicians and nurses.
In simple words: This procedure involves inserting a thin tube into a dialysis access point to take pictures of the blood vessels used for dialysis. If a blockage is found, a small balloon is used to widen the narrowed area, improving blood flow.
This CPT code encompasses the introduction of needles and/or catheters into the dialysis circuit, followed by diagnostic angiography of the entire circuit (from the arterial anastomosis and adjacent artery through the entire venous outflow, including the inferior or superior vena cava).The procedure includes all direct punctures, catheter placements, contrast injections, necessary imaging, fluoroscopic guidance, radiological supervision and interpretation, and image documentation and reporting. Additionally, it includes transluminal balloon angioplasty of the peripheral dialysis segment, with all associated imaging and radiological supervision and interpretation.
Example 1: A patient with an arteriovenous fistula (AVF) experiences decreased blood flow during hemodialysis.Angiography reveals stenosis in the peripheral segment of the AVF.Transluminal balloon angioplasty is performed using code 36902 to restore adequate flow., A patient with an arteriovenous graft (AVG) presents with thrombosis in the peripheral segment. After thrombectomy (36904), residual stenosis is identified on angiography.Angioplasty is performed using code 36902 to improve vessel patency., A patient with a newly created AVF undergoes diagnostic angiography to assess the patency of the access.Angiography reveals a critical stenosis at the anastomosis, requiring transluminal balloon angioplasty using code 36902 to maintain the access for dialysis.
Complete medical history, including dialysis access details (type, date of creation, previous interventions).Pre-procedure images (if available).Detailed procedure notes outlining the access site, catheterization techniques, contrast used, angiographic findings (location and severity of stenosis), angioplasty technique (balloon size, pressure, number of inflations), post-angioplasty images, and assessment of patency.Final report including interpreted angiographic images.
** Ultrasound guidance for puncture is not typically included but may be separately reported with 76937 if performed and documented appropriately.If catheterization extends beyond the peri-anastomotic segment into the inflow artery, additional catheterization codes may be reported (e.g., 36215).Removal of the arterial plug during declot/thrombectomy is included in the fistula thrombectomy code.
- Revenue Code: P9A (Dialysis Services)
- RVU: This information is not provided in the source.Refer to CMS's current relative value units for CPT code 36902 for the most up-to-date information.
- Global Days: The global period for this procedure is not explicitly defined in the provided text.Further research into current CPT guidelines is needed.
- Payment Status: Active
- Modifier TC rule: The provided text does not specify the applicability of a Technical Component (TC) modifier for this code.
- Fee Schedule: This information is not available in the source data.Consult fee schedules from relevant payers for historical fee information.
- Specialties:Vascular Surgery, Interventional Radiology, Nephrology
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center