Summary & Overview
CPT 36902: Angiography and Balloon Angioplasty of Dialysis Circuit
CPT code 36902 is a critical billing code for procedures involving diagnostic angiography and transluminal balloon angioplasty within a dialysis circuit. This code is widely used in vascular surgery and interventional radiology to address complications such as stenosis or stricture in patients undergoing renal dialysis. The procedure is essential for maintaining the functionality of dialysis access, which is vital for patients with end stage renal disease.
Major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, provide coverage for services billed under CPT code 36902. The code is typically utilized in outpatient hospital settings and is relevant to providers specializing in vascular surgery, thoracic surgery, and interventional radiology.
Readers will gain insight into the clinical context of CPT code 36902, including its role in managing dialysis circuit complications, the types of providers who perform the procedure, and the typical site of service. The publication also covers associated modifiers, relevant ICD-10 diagnoses, and related CPT codes, offering a comprehensive overview of billing and policy considerations for this procedure. Benchmarks and policy updates are included to inform stakeholders about current trends and requirements in medical billing for vascular access interventions.
CPT Code Overview
CPT code 36902 describes the introduction of needle(s) and/or catheter(s) into a dialysis circuit, accompanied by diagnostic angiography and transluminal balloon angioplasty of the peripheral dialysis segment. This procedure includes all direct punctures, catheter placements, injections of contrast, and necessary imaging from the arterial anastomosis and adjacent artery through the entire venous outflow, including the inferior or superior vena cava. It also encompasses fluoroscopic guidance, radiological supervision and interpretation, image documentation, and reporting. The service type is Surgical Procedures on Arteries and Veins, and it is most commonly performed in an Outpatient Hospital (POS 22) setting.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an individual with end stage renal disease who is dependent on hemodialysis via a vascular access circuit, such as an arteriovenous (AV) fistula or graft. The patient presents with signs of access dysfunction, such as decreased dialysis flow rates or abnormal physical findings suggesting stenosis or stricture within the dialysis circuit. The clinical workflow includes evaluation by a vascular surgeon or interventional radiologist, followed by percutaneous access to the circuit. Diagnostic angiography is performed to assess the entire circuit, and if a peripheral segment stenosis is identified, transluminal balloon angioplasty is carried out to restore patency. Imaging and radiological supervision are integral throughout the procedure, and a formal report is generated documenting the findings and intervention.
Coding Specifications
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Modifiers:
26- Professional Component: Used when only the physician's interpretation and report are billed, not the technical portion.TC- Technical Component: Used when only the technical portion (equipment, supplies, staff) is billed.59- Distinct Procedural Service: Used to indicate that a procedure or service is distinct or independent from other services performed on the same day.LT- Left Side: Used to specify that the procedure was performed on the left side of the body.
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Provider Taxonomies: