CPT® Code 36147

Introduction of needle and/or catheter, arteriovenous shunt created for dialysis (graft/fistula); initial access with complete radiological evaluation of dialysis access, including fluoroscopy, image documentation and report (includes access of shunt, injection[s] of contrast, and all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava)

The procedure described by CPT® Code 36147 involves the introduction of a needle and/or catheter into an existing arteriovenous (AV) shunt that has been created for dialysis purposes, which may include various types such as a graft or fistula. This initial access is critical for performing a complete radiological evaluation of the dialysis access. The process begins with the disinfection of the skin over the AV shunt, followed by the administration of a local anesthetic to ensure patient comfort during the procedure. Once the area is prepared, a needle or catheter is carefully introduced into the AV shunt. This access allows for the injection of medication and/or radiopaque contrast material, which is essential for imaging purposes. A comprehensive fluoroscopic evaluation is then conducted, which includes obtaining fluoroscopic images that document the condition of the shunt, the arterial and venous anastomosis sites, and the adjacent arteries. The evaluation extends through the entire venous outflow, encompassing the inferior and superior vena cava. Any abnormalities observed during this imaging process are meticulously noted. After the imaging is completed, the needle or catheter is removed, and pressure is applied to the puncture site to minimize bleeding. Finally, the physician is responsible for providing a written interpretation and report of the findings from the evaluation, ensuring that all relevant details are documented for future reference and care planning.