CPT® Code 36909

Add-On Code

Dialysis circuit permanent vascular embolization or occlusion (including main circuit or any accessory veins), endovascular, including all imaging and radiological supervision and interpretation necessary to complete the intervention (List separately in addition to code for primary procedure)

The CPT® Code 36909 refers to the procedure of permanent vascular embolization or occlusion of the dialysis circuit, which includes both the main circuit and any accessory veins. This endovascular intervention is specifically designed to address various complications associated with dialysis, such as dialysis-related steal syndrome, critical hand ischemia, venous aneurysm, central venous occlusion syndrome that cannot be treated through endovascular recanalization, and hyperdynamic heart failure. The procedure begins with accessing the dialysis circuit using a needle, through which a guidewire is introduced into the vessel. Following this, a vascular sheath is placed to facilitate the introduction of a catheter. The use of contrast dye allows for the visualization of the target area within the dialysis circuit or accessory veins via fluoroscopy. An embolization agent, which may include materials such as gelfoam, particulate agents, liquid sclerosing agents, or liquid glue, or an occlusion device like a metallic plug or coil, is then delivered to the targeted site through the catheter. After the embolization or occlusion is performed, post-procedure angiography is conducted to confirm the success of the intervention. The catheter is subsequently removed, and a purse string suture may be applied to manage any bleeding before the vascular sheath is taken out. It is important to note that CPT® Code 36909 encompasses all necessary imaging and radiological supervision and interpretation required to complete the procedure and is reported separately in addition to the primary procedure code.