CPT® Code 36902

Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava, fluoroscopic guidance, radiological supervision and interpretation and image documentation and report; with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty

The procedure described by CPT® Code 36902 involves the introduction of needle(s) and/or catheter(s) into the dialysis circuit, accompanied by diagnostic angiography. This process is essential for visualizing the hemodialysis circuit, which may include a central venous catheter (CVC), an arteriovenous (AV) fistula, or a synthetic AV graft. The primary goal of this procedure is to identify and address issues such as stenosis or obstruction that can lead to complications like low blood flow, elevated pre-pump arterial pressure, or high venous return pressure. The procedure begins with the insertion of a needle or catheter into a large vein, such as the vena cava, internal jugular, or femoral vein, allowing for blood withdrawal and return through separate lumens in the case of a CVC. In the case of an AV fistula, an artery is surgically connected to a vein, bypassing the capillaries, while a synthetic graft serves a similar purpose when vessels are not in close proximity. Over time, these access points can become narrowed due to conditions like intimal hyperplasia or thrombosis. The diagnostic angiography component involves accessing the AV fistula or graft with a needle, threading a guidewire, and using fluoroscopy to inject contrast dye, which visualizes the vessels throughout the venous outflow. If stenosis is detected in the peripheral dialysis segment, the procedure may include transluminal balloon angioplasty, where a balloon-tipped catheter is used to dilate the narrowed area. This comprehensive approach ensures that any obstructions are identified and treated effectively, thereby maintaining the functionality of the dialysis circuit.