2025 CPT code 36908
(Active) Effective Date: N/A Surgery - Surgical Procedures on the Cardiovascular System Feed
Transcatheter placement of intravascular stent(s), central dialysis segment, performed through dialysis circuit, including all imaging and radiological supervision and interpretation required to perform the stenting, and all angioplasty in the central dialysis segment.
Modifiers may be applicable in certain circumstances, such as reduced services (modifier 52) or unusual procedural services (modifier 22). Use of specific modifiers is subject to individual payer policies and accurate clinical documentation of the circumstances necessitating modifier usage.
Medical necessity for this procedure is established by the presence of a central venous stenosis in a dialysis circuit that is compromising dialysis adequacy or causing other complications.
With the patient appropriately prepped and anesthetized and during a primary procedure on the dialysis circuit, the provider discovers a narrowing or obstruction in a central segment of the circulation. He uses dilators or a balloon passed through the catheter to open up the vessel after which he passes a stent (a tubelike device) through the catheter into the area to keep the lumen (interior diameter) of the vessel open. He confirms that the vessel is now open. He continues with the primary procedure, at the end of which he withdraws the catheter and puts pressure on the incision to control the bleeding.
In simple words: This procedure involves placing a stent in the central part of your dialysis circuit to keep the blood vessel open. It is done through a small puncture in your dialysis circuit and includes taking pictures of the area with X-rays to guide the procedure. The doctor will also open up any narrowed blood vessels in the area using a tiny balloon.
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 transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty; with transcatheter placement of intravascular stent(s), central dialysis segment, performed through dialysis circuit, including all imaging and radiological supervision and interpretation required to perform the stenting, and all angioplasty in the central dialysis segment (List separately in addition to code for primary procedure)
Example 1: A patient with a thrombosed arteriovenous fistula undergoes thrombectomy. During the procedure, a stenosis is found in the central venous segment, requiring angioplasty and stenting., A patient on hemodialysis presents with decreased flow in their dialysis circuit. Angiography reveals a stenosis in the central venous segment. The stenosis is treated with angioplasty and a stent is placed to maintain patency., A patient with an arteriovenous graft develops a stenosis in the central venous segment causing difficulty with dialysis. Angioplasty and stent placement are performed to restore adequate flow.
Documentation should include details of the primary procedure during which the central venous stenosis was identified, the location and severity of the stenosis, the methods used for angioplasty and stenting, and confirmation of restored flow.Operative and procedural notes must include the diagnosis, the clinical indication for the procedure, and a description of the procedure performed.
** Code 36908 is reported only once per session, regardless of the number of stents placed or lesions treated in the central segment.
- Payment Status: Active
- Specialties:Interventional Radiology, Vascular Surgery, Nephrology
- Place of Service:Ambulatory Surgical Center, Hospital Inpatient, Hospital Outpatient, Office