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Official Description

Insertion of cannula for hemodialysis, other purpose (separate procedure); arteriovenous, external (Scribner type)

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 36810 involves the insertion of a cannula specifically for hemodialysis or other purposes, utilizing an external arteriovenous connection known as the Scribner type. A cannula is a flexible tube that is inserted into a blood vessel to facilitate the flow of blood during hemodialysis, a process that removes waste products and excess fluid from the blood when the kidneys are not functioning properly. In this procedure, suitable veins and arteries are selected, typically from the nondominant forearm or the ankle, to create a connection that allows for efficient blood access during dialysis treatments. The Scribner-type cannula is characterized as a semi-permanent shunt, which is less commonly used in contemporary practice but serves as a critical option for patients requiring hemodialysis. The procedure involves careful exposure and incision of the selected blood vessels, followed by the secure placement of cannulas into both an artery and a vein. These cannulas are then connected externally using synthetic materials, ensuring that they can be easily accessed for dialysis sessions. This code is specifically designated for the initial placement of the shunt, which is essential for establishing a reliable access point for ongoing dialysis treatment.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The procedure associated with CPT® Code 36810 is indicated for patients requiring hemodialysis due to renal failure or other conditions necessitating the removal of waste products from the blood. The following conditions may warrant the use of this procedure:

  • Renal Failure Patients with acute or chronic renal failure who require regular hemodialysis treatments to manage their condition.
  • End-Stage Renal Disease (ESRD) Individuals diagnosed with ESRD, where kidney function has declined to the point that dialysis is necessary for survival.
  • Vascular Access Needs Patients who need a reliable vascular access point for hemodialysis, particularly when other access methods are not viable.

2. Procedure

The procedure for CPT® Code 36810 involves several critical steps to ensure proper placement of the Scribner-type arteriovenous cannula:

  • Step 1: Selection of Vessels The physician selects a suitable peripheral artery and vein for cannulation, typically the radial artery and cephalic vein at the wrist or the tibial artery and saphenous vein at the ankle. The choice of vessels is crucial for optimal blood flow during dialysis.
  • Step 2: Exposure and Incision The selected blood vessels are exposed through a surgical incision. This step is essential to access the vessels directly for cannula insertion.
  • Step 3: Cannula Insertion One cannula is inserted into the selected artery, and another is inserted into the selected vein. This dual insertion allows for the effective circulation of blood during the dialysis process.
  • Step 4: Securing Cannulas The cannulas are secured in place with sutures to prevent movement and ensure stability during use.
  • Step 5: Ligation of Vessels The distal segments of both the artery and vein are ligated to maintain the integrity of the vascular system and facilitate proper blood flow through the cannulas.
  • Step 6: External Connection The two cannulas are connected externally using a rigid piece of Teflon or other synthetic material, which is placed over a stainless steel arm plate when not in use. This connection is designed to allow for easy access during dialysis sessions.
  • Step 7: Connection to Dialysis Machine During the dialysis procedure, the Teflon segment is removed, and the cannulas are connected to tubing that links directly to the dialysis machine, enabling the treatment to commence.

3. Post-Procedure

After the insertion of the Scribner-type arteriovenous cannula, patients may require monitoring for any complications such as infection or thrombosis at the cannulation sites. It is essential to ensure that the cannulas remain patent and functional for effective dialysis. Patients will typically be instructed on care for the cannula sites, including keeping the area clean and monitoring for any signs of complications. Regular follow-up appointments may be necessary to assess the function of the cannula and to determine if any revisions or closures are needed in the future. If the shunt requires revision, the existing cannulas may be removed, and new ones inserted, while closure involves exposing the cannulas, cutting securing sutures, and suturing the vessels and skin closed.

Short Descr INSERTION OF CANNULA
Medium Descr INSJ CANNULA HEMO OTH PURPOSE SPX ARVEN XTRNL
Long Descr Insertion of cannula for hemodialysis, other purpose (separate procedure); arteriovenous, external (Scribner type)
Status Code Active Code
Global Days 000 - Endoscopic or Minor Procedure
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 09 - Concept does not apply.
Assistant Surgeon (80, 82) 1 - Statutory payment restriction for assistants at surgery applies 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 Hospital Part B services paid through a comprehensive APC
ASC Payment Indicator Device-intensive procedure added to ASC list in CY 2008 or later; paid at adjusted rate.
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P2F - Major procedure, cardiovascular-Other
MUE 1
CCS Clinical Classification 57 - Creation, revision and removal of arteriovenous fistula or vessel-to-vessel cannula for dialysis
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
AG Primary physician
GC This service has been performed in part by a resident under the direction of a teaching physician
GV Attending physician not employed or paid under arrangement by the patient's hospice provider
LT Left side (used to identify procedures performed on the left side of the body)
RT Right side (used to identify procedures performed on the right side of the body)
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
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