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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.
© Copyright 2026 Coding Ahead. All rights reserved.
The procedure described by CPT® Code 36147 is indicated for patients who require access to an arteriovenous shunt for dialysis. This may include individuals with chronic kidney disease or end-stage renal disease who need hemodialysis. The procedure is performed to evaluate the patency and functionality of the dialysis access, ensuring that the shunt is operating effectively for the patient's treatment needs.
The procedure begins with the preparation of the patient, where the skin over the existing arteriovenous (AV) dialysis shunt is disinfected to reduce the risk of infection. Following this, a local anesthetic is administered to ensure the patient experiences minimal discomfort during the procedure. Once the area is adequately anesthetized, a needle or catheter is introduced into the AV shunt. This access point is crucial as it allows for the subsequent injection of radiopaque contrast material, which is necessary for imaging purposes. After the introduction of the needle or catheter, a complete fluoroscopic radiological evaluation of the dialysis access is performed. This evaluation includes the injection of contrast material, which enhances the visibility of the shunt and surrounding structures during imaging. Fluoroscopic images are obtained to document the condition of the shunt, including the arterial and venous anastomosis sites, adjacent arteries, and the entire venous outflow pathway, which extends to the inferior and superior vena cava. The physician carefully evaluates these images for any abnormalities that may indicate issues with the shunt's function or patency. Upon completion of the imaging process, the needle or catheter is removed, and pressure is applied to the puncture site to control any bleeding. The physician then prepares a written interpretation and report of the findings, which includes a detailed account of the evaluation and any abnormalities noted during the procedure.
After the completion of the procedure, patients may be monitored for any immediate complications, such as bleeding or infection at the puncture site. It is essential to ensure that the access site is stable and that the patient is comfortable. The physician's report will provide critical information regarding the condition of the AV shunt and any necessary follow-up actions. Patients may be advised on care for the puncture site and any signs of complications to watch for in the days following the procedure. Additionally, any therapeutic interventions that may be required based on the findings will be discussed with the patient during follow-up visits.
| Short Descr | ACCESS AV DIAL GRFT FOR EVAL | Medium Descr | INTRO NDL/CATH AV SHUNT IST ACCESS W/ RAD EVAL | Long Descr | 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) | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 9 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Procedure or Service, Multiple Reduction Applies | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5E - Ambulatory procedures - other | MUE | Not applicable/unspecified. | CCS Clinical Classification | 57 - Creation, revision and removal of arteriovenous fistula or vessel-to-vessel cannula for dialysis |
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