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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.
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The procedure associated with CPT® Code 36148 is indicated for patients who require additional access to an existing arteriovenous (AV) shunt created for dialysis. This may be necessary in various clinical scenarios, including:
The procedure for CPT® Code 36148 involves several critical steps to ensure proper access to the AV shunt for therapeutic interventions. The first step is the disinfection of the skin over the existing AV shunt, which is essential to minimize the risk of infection. Following this, a local anesthetic is administered to the patient to ensure comfort during the procedure. Once the area is adequately prepared, a second needle or catheter is introduced into the AV shunt. This introduction is performed carefully to avoid damaging the existing shunt or surrounding structures. The purpose of this additional access is to facilitate therapeutic interventions, which may include the injection of medications or the administration of radiopaque contrast for imaging purposes. After the introduction of the needle or catheter, a complete fluoroscopic radiological evaluation of the dialysis access is conducted. This evaluation includes obtaining fluoroscopic images that assess the shunt, the arterial and venous anastomosis sites, and the adjacent vascular structures, including the inferior and superior vena cava. Any abnormalities identified during this evaluation are documented for further review. Once the necessary interventions are completed, the needle or catheter is removed, and pressure is applied to the puncture site to control any bleeding. The physician then provides a written interpretation and report of the findings from the procedure, ensuring that all relevant information is documented for future reference.
After the completion of the procedure associated with CPT® Code 36148, it is essential to monitor the patient for any immediate complications, such as bleeding or infection at the puncture site. The application of pressure to the site helps to minimize the risk of hematoma formation. Patients may be advised to rest and avoid strenuous activities for a short period following the procedure to promote healing. Additionally, the physician's written report will include findings from the fluoroscopic evaluation, which may guide any further treatment or interventions required. Follow-up appointments may be scheduled to assess the functionality of the AV shunt and to ensure that the therapeutic interventions have been effective.
| Short Descr | ACCESS AV DIAL GRFT FOR PROC | Medium Descr | INTRO NDL/CATH AV SHUNT ADDL ACCESS THER IVNTJ | Long Descr | 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) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No 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 | Items and Services Packaged into APC Rates | 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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