CPT® Code 36908

Add-On Code

Transcatheter placement of intravascular stent(s), central dialysis segment, performed through dialysis circuit, including all imaging and radiological supervision and interpretation required to perform the stenting, and all angioplasty in the central dialysis segment (List separately in addition to code for primary procedure)

The procedure described by CPT® Code 36908 involves the transcatheter placement of intravascular stent(s) specifically within the central dialysis segment. This procedure is essential for restoring adequate blood flow through narrowed or obstructed veins that are critical for hemodialysis, such as the axillary vein, subclavian vein, innominate vein, and vena cava. Patients suffering from hemodialysis-related central venous occlusive disease (CVOD) may experience symptoms such as elevated urea recirculation, increased venous dialysis pressure, and arm edema, which indicate compromised blood flow. The procedure begins with accessing the central venous dialysis segment through an arteriovenous (AV) graft or fistula, where a needle is used to puncture the graft. A guidewire is then threaded through the needle, and the needle is replaced with a vascular sheath to facilitate further access. Angiography is performed to visualize the central venous segments, allowing for the identification of any stenosis. If a narrowing is detected, transluminal balloon angioplasty is performed to dilate the affected area. Following this, if residual stenosis is present, a fine mesh or wire stent is deployed to maintain vessel patency. The entire process includes all necessary imaging and radiological supervision, ensuring that the procedure is conducted safely and effectively. The stent placement is a critical intervention that not only alleviates symptoms but also enhances the overall efficacy of the dialysis treatment.