2025 CPT code 36820
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Cardiovascular System Surgery Feed
Open arteriovenous anastomosis created by forearm vein transposition.
Modifiers may be applicable, depending on the circumstances, such as -58 for staged procedures, -59 for distinct procedural services, and others as clinically indicated.
The procedure is medically necessary when other suitable access sites for hemodialysis (e.g., upper arm veins) are unavailable or unsuitable due to anatomical variations, prior surgeries, or other factors. Documentation must support the clinical need for this procedure.
The vascular surgeon or a qualified physician performs the arteriovenous anastomosis. This includes pre-operative planning, surgical technique (incision, vein transposition, anastomosis, hemostasis), and post-operative care.
In simple words: The doctor creates a connection between a vein and an artery in the forearm through an open surgical procedure, using a section of the forearm vein. This new connection makes it easier to access the blood vessels for hemodialysis, a treatment for kidney failure.
This CPT code, 36820, represents the open surgical creation of an arteriovenous anastomosis utilizing forearm vein transposition.The procedure involves surgically connecting a vein to an artery in the forearm, typically to establish vascular access for hemodialysis in patients with kidney failure. This technique involves creating a tunnel between the vein and artery, dissecting a portion of the vein, and then connecting it to the artery.Hemostasis and wound closure are integral parts of the procedure.
Example 1: A 60-year-old male with end-stage renal disease requires hemodialysis access.The surgeon performs a forearm vein transposition to create an arteriovenous fistula., A 55-year-old female with chronic kidney disease needs an arteriovenous fistula for hemodialysis.Due to limited upper arm vein options, a forearm vein transposition is chosen for fistula creation., A 70-year-old patient with ESRD and unsuitable upper arm veins undergoes a forearm vein transposition to create a hemodialysis access point. This approach is selected because of previous surgeries in the upper arm compromising vein suitability for fistula construction.
Preoperative assessment including vascular mapping, intraoperative findings (vein and artery details, anastomosis technique), postoperative assessment of patency and healing.Detailed operative report, including images if available.
** Accurate documentation of the type of vein used and the specific surgical technique is essential for proper coding. This procedure might be part of a staged process with additional codes for pre or post-operative care, depending on the context.
- Revenue Code: P2F (MAJOR PROCEDURE, CARDIOVASCULAR - OTHER)
- Payment Status: Active
- Modifier TC rule: Not applicable
- Specialties:Vascular Surgery, Nephrology
- Place of Service:Ambulatory Surgical Center, Hospital Outpatient Department