In simple words: A minimally invasive procedure is used to create a connection between an artery and a vein in your arm for hemodialysis access.This is done through a single small incision.

Percutaneous arteriovenous fistula creation, upper extremity, single access of both the peripheral artery and peripheral vein, including fistula maturation procedures (e.g., transluminal balloon angioplasty, coil embolization) when performed, including all vascular access, imaging guidance and radiologic supervision and interpretation. Do not report 36836 in conjunction with 36005, 36140, 36215, 36216, 36217, 36218, 36245, 36246, 36247, 36837, 36901, 36902, 36903, 36904, 36905, 36906, 36907, 36908, 36909, 37236, 37238, 37241, 37242, 37246, 37248, 37252, 75710, 75716, 75820, 75822, 75894, 75898, 76937, 77001. For arteriovenous fistula creation via an open approach, see 36800, 36810, 36815, 36818, 36819, 36820, 36821. For percutaneous arteriovenous fistula creation in any location other than the upper extremity, use 37799. Codes 36836 and 36837 describe percutaneous arteriovenous fistula creation in the upper extremity for hemodialysis access. This includes image-guided percutaneous access into a peripheral artery and peripheral vein via single access (36836) or two separate access sites (36837). The artery and vein are approximated, and then energy (e.g., thermal) is applied to establish the fistulous communication between the two vessels. Fistula maturation procedures promote blood flow through the newly created fistula by augmentation (e.g., angioplasty) or redirection (e.g., coil embolization of collateral pathways) of blood flow. Codes 36836 and 36837 include all vascular access, angiography, imaging guidance, and blood flow redirection or maturation techniques (e.g., transluminal balloon angioplasty, coil embolization) performed for fistula creation. These procedures may not be reported separately with 36836 or 36837 when performed at the same operative session.

Example 1: A patient with end-stage renal disease requires an arteriovenous fistula for hemodialysis.The physician performs a percutaneous creation in the upper extremity using a single access site for both artery and vein., During a percutaneous AV fistula creation, the physician performs balloon angioplasty to mature the fistula and ensure adequate blood flow., A patient with a failing arteriovenous fistula undergoes a percutaneous revision using a single access site, with the physician performing coil embolization of competing veins to redirect blood flow to the fistula.

Documentation should include details of the percutaneous procedure, including the access site location, imaging guidance used, any maturation procedures performed (e.g., angioplasty, coil embolization), and confirmation of successful fistula creation.The medical necessity for the procedure, related to the patient's renal condition and need for hemodialysis, should also be documented.