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2025 CPT code 36837

Percutaneous arteriovenous fistula creation in the upper extremity using separate access sites for the peripheral artery and vein. Includes fistula maturation procedures (e.g., angioplasty, coil embolization), vascular access, imaging guidance, and radiologic supervision and interpretation.

Modifiers are allowed. Common modifiers include 22 (Increased Procedural Services), 51 (Multiple Procedures), 59 (Distinct Procedural Service) etc.

Medical necessity for this procedure is established by the patient's diagnosis of end-stage renal disease and the need for vascular access for hemodialysis.

IMPORTANT:For open arteriovenous fistula creation, see 36800, 36810, 36815, 36818, 36819, 36820, 36821. For percutaneous arteriovenous fistula creation in any location other than the upper extremity, use 37799.

In simple words: This procedure creates a connection between an artery and a vein in your arm for dialysis.Two small incisions are made, one for the artery and one for the vein. Using imaging guidance, the doctor connects the artery and vein.Sometimes, additional procedures are done to help blood flow through the new connection.

This code describes a percutaneous procedure to create an arteriovenous (AV) fistula in the upper extremity for hemodialysis access.The physician uses two separate access sites, one for the peripheral artery and one for the peripheral vein. The procedure includes all necessary steps such as vascular access, imaging guidance, and any required maturation procedures like balloon angioplasty or coil embolization to ensure proper fistula function. Radiological supervision and interpretation are also included.

Example 1: A patient with end-stage renal disease requires an AV fistula for hemodialysis. The physician performs a percutaneous creation of the fistula in the upper extremity using two separate access points for the artery and vein. Angioplasty is performed to facilitate maturation., A patient with unsuitable veins for a traditional AV fistula undergoes percutaneous creation using the Ellipsys Vascular Access System. The procedure involves two separate punctures and coil embolization of a competing vein., A patient requires a percutaneous AV fistula creation. During the procedure, the physician encounters difficulty and converts to an open procedure. The open procedure would be coded separately.

Documentation should include: patient history, indication for the procedure, location of the access sites (artery and vein used), description of the technique used, imaging guidance used, maturation procedures performed (if any), intraoperative findings, and complications (if any).

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