2025 CPT code 36903
Effective Date: N/A Surgery - Cardiovascular System Feed
Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava, fluoroscopic guidance, radiological supervision and interpretation and image documentation and report; with transcatheter placement of intravascular stent(s), peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the stenting, and all angioplasty within the peripheral dialysis segment.
Modifiers may apply in certain situations, such as reduced services (modifier 52) or distinct procedural services (modifier 59). Refer to CPT guidelines.
Medical necessity must be established by documenting the reduced dialysis flow or access dysfunction due to stenosis or occlusion in the peripheral segment. The documentation should support that the intervention is necessary to maintain or restore adequate dialysis access.
The physician is responsible for prepping and anesthetizing the patient, accessing the dialysis circuit, performing the angiography, placing the stent, and managing any complications. They also supervise the procedure, interpret the images, and create a report.
In simple words: The doctor inserts a small tube into your dialysis access point to take pictures of your veins and arteries using a special dye. If they find a blockage, they will insert a small mesh tube called a stent to keep the vessel open.This procedure also includes widening any narrowed vessels in the area.
This code describes a procedure where the physician accesses the dialysis circuit via needle or catheter, performs angiography to assess the circuit, and then places a stent in the peripheral segment. This includes all necessary imaging, contrast injections, and radiological supervision. Angioplasty within the peripheral segment is also included.
Example 1: A patient with a failing arteriovenous fistula (AVF) undergoes this procedure to address a stenosis in the peripheral segment, restore proper blood flow, and maintain dialysis access., A patient with an occluded AVG has a thrombectomy (36904) followed by angioplasty and stenting (36906), but the peripheral segment also has a stenosis requiring treatment. Code 36903 would be reported to capture the additional stenting and any angioplasty performed in the peripheral segment during the same session., A patient presents with reduced dialysis flow. Angiography reveals a stenosis in the peripheral segment of the dialysis circuit. Angioplasty is attempted, but the stenosis doesn't respond well, so a stent is placed to maintain patency. This is reported with 36903.
Documentation should include details of the angiography findings, location and severity of the stenosis or occlusion, type and size of the stent placed, any angioplasty performed, and any complications encountered. Pre- and post-procedure assessment of dialysis flow is also important.
** Ultrasound guidance (76937) may be separately reported if used for dialysis circuit access, especially in challenging cases like new or failing AVFs. If separate inflow artery issues are addressed, additional catheterization codes may apply.
- Specialties:Interventional Radiology, Vascular Surgery, Nephrology
- Place of Service:Ambulatory Surgical Center, Hospital Outpatient, Inpatient Hospital