CPT® Code 36903

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 transcatheter placement of intravascular stent(s), peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the stenting, and all angioplasty within the peripheral dialysis segment

The procedure described by CPT® Code 36903 involves the introduction of needles and/or catheters into the dialysis circuit, accompanied by diagnostic angiography. This process is essential for visualizing the hemodialysis circuit, which may include various components such as central venous catheters (CVCs), arteriovenous (AV) fistulas, or synthetic AV grafts. The primary goal of this procedure is to assess the dialysis circuit for any stenosis or obstruction that could lead to complications such as low blood flow, elevated pre-pump arterial pressure, or high venous return pressure. The procedure begins with the insertion of a double lumen catheter or two separate catheters into a large vein, such as the vena cava, internal jugular, or femoral vein, allowing for the withdrawal and return of blood during dialysis. In cases where an AV fistula is utilized, an artery is surgically connected to a vein, bypassing the capillaries, while a synthetic graft serves a similar purpose when the vessels are not in close proximity. Over time, these access points may become narrowed due to conditions like intimal hyperplasia or thrombosis, necessitating the need for diagnostic angiography. This angiography involves accessing the AV fistula or graft with a small needle, threading a guidewire, and using fluoroscopy to inject contrast dye for visualization of the vessels. If stenosis is detected, balloon angioplasty may be performed, followed by the placement of a stent to maintain vessel patency. The entire procedure is conducted under fluoroscopic guidance, ensuring accurate imaging and interpretation, and concludes with the documentation of the findings and any interventions performed.