Summary & Overview
CPT 36831: Arteriovenous Fistula Thrombectomy
CPT code 36831 describes a surgical thrombectomy for an arteriovenous fistula, in which the provider opens an autogenous or nonautogenous fistula and removes clot at the arterial-venous anastomosis without performing fistula revision. This code is clinically important because maintaining functional vascular access is essential for patients receiving hemodialysis; timely thrombectomy can restore access and reduce the need for new access creation.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical sites of service, and service type, followed by benchmark considerations and common billing practices tied to this procedure.
The publication provides national-level benchmarks and policy context relevant to reimbursement and utilization for surgical management of thrombosed dialysis fistulas. It highlights clinical indications for the procedure, common billing and coding considerations, and areas where payer policy updates may affect coverage or prior authorization requirements. Data not available in the input are noted where applicable. This summary is intended to help billing managers, surgical providers, and policy analysts quickly understand the code's clinical purpose and its relevance across major payers.
Billing Code Overview
CPT code 36831 describes a surgical procedure to open an autogenous or nonautogenous arteriovenous fistula and remove an existing clot at the arteriovenous anastomosis without revising the fistula. This procedure addresses thrombosis that impairs vascular access used for hemodialysis.
Service type: Surgical thrombectomy of an arteriovenous fistula
Typical site of service: Hospital operating room or ambulatory surgical center, commonly performed on the upper arm or forearm where dialysis fistulas are located.
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with end-stage renal disease on maintenance hemodialysis presents to the vascular surgery service with sudden loss of thrill and inability to use the left radiocephalic arteriovenous fistula for dialysis. Physical exam and duplex ultrasound confirm an acute thrombosis confined to the native fistula without evidence of aneurysmal degeneration or anastomotic failure. The patient is taken to the operating room for surgical thrombectomy of the arteriovenous fistula. Under regional or general anesthesia, the vascular surgeon exposes the fistula, surgically opens the venous segment at or near the anastomosis, and removes thrombus using simple clot extraction techniques and limited irrigation. No revision of the fistula anastomosis or interposition grafting is performed during the same encounter. Hemostasis is achieved and the incision is closed. The patient is monitored in a post-anesthesia care area and returned to the dialysis schedule once patency is confirmed by clinical exam and/or duplex study.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the physician's professional services separate from technical facility services (rare for surgical CPT). |
50 |