CPT® Code 36148

Introduction of needle and/or catheter, arteriovenous shunt created for dialysis (graft/fistula); additional access for therapeutic intervention (List separately in addition to code for primary procedure)

The CPT® Code 36148 refers to the introduction of a needle and/or catheter into an existing arteriovenous (AV) shunt that has been created for dialysis purposes, specifically for the purpose of establishing an additional access point for therapeutic interventions. This procedure is performed when there is a need for further access to the AV shunt, which may be a graft or fistula, to facilitate additional therapeutic measures. The process begins with the disinfection of the skin over the existing AV shunt, followed by the administration of a local anesthetic to ensure patient comfort during the procedure. A needle or catheter is then introduced into the AV shunt, allowing for the injection of medications or radiopaque contrast as necessary. A comprehensive fluoroscopic evaluation of the dialysis access is conducted, which includes obtaining fluoroscopic images to assess the shunt, the arterial and venous anastomosis sites, and the surrounding vascular structures, including the inferior and superior vena cava. Any abnormalities identified during this evaluation are documented. After the procedure, the needle or catheter is removed, and pressure is applied to the puncture site to minimize bleeding. The physician is responsible for providing a written interpretation and report of the findings from the procedure. It is important to note that this code is used in conjunction with the primary procedure code for the AV shunt and is reported separately to indicate the additional access for therapeutic intervention.