Summary & Overview

CPT 36832: Revision of Arteriovenous Fistula (Non-Thrombectomy)

CPT code 36832 represents the surgical opening and revision of an autogenous or nonautogenous arteriovenous fistula without thrombectomy. This procedure is used to restore or improve vascular access for hemodialysis, typically performed on fistulas located in the forearm or upper arm. Nationally, procedures to maintain functional dialysis access are critical to ongoing outpatient and inpatient renal replacement care, making accurate coding and coverage understanding essential for hospitals, ambulatory surgery centers, and clinicians.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical indication and service setting, an outline of payer coverage considerations and common procedural modifiers, and pointers to related billing and coding topics. The summary provides benchmarks and policy context relevant to reimbursements, prior authorization practices, and site-of-service determinations where available. If specific payer policies or local coverage determinations apply, those details should be consulted directly from each payer.

This publication helps billing managers, vascular surgeons, nephrology programs, and revenue cycle teams understand where CPT code 36832 fits within the spectrum of dialysis access procedures and what to review when preparing claims or evaluating coverage decisions.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare36832CPTarteriovenous-fistuladialysis-accessvascular-surgeryoutpatient-surgeryhemodyalysisrevascularization

Billing Code Overview

CPT code 36832 describes a surgical procedure to open and revise an arteriovenous fistula without performing a thrombectomy. The operation involves surgically opening an autogenous or nonautogenous fistula and revising the connection between an artery and a vein, commonly located in the upper arm or forearm, to restore or improve vascular access used for hemodialysis.

Service type: Surgical revision of arteriovenous fistula (non-thrombectomy)

Typical site of service: Operating room, ambulatory surgery center, or hospital outpatient setting

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 62-year-old patient with end-stage renal disease (ESRD) on maintenance hemodialysis presents with progressive access dysfunction of a left forearm autogenous radiocephalic arteriovenous fistula. The fistula demonstrates poor thrill and prolonged bleeding after needle removal but no clinical evidence of acute thrombosis. The vascular surgeon evaluates the access in the ambulatory vascular clinic and schedules a planned operative revision under monitored anesthesia care. In the operating room, after sterile preparation and local/regional anesthesia with conscious sedation, the surgeon surgically opens the fistula site, inspects the arterial anastomosis and venous outflow, and performs revision of the arteriovenous anastomosis (taking down a stenotic anastomosis and re-establishing a better arterial-venous connection). No thrombectomy is performed and no thrombus is removed. The procedure is performed to restore reliable dialysis access and reduce access-related complications. Typical documentation includes pre- and postoperative vascular examination, indication for revision (e.g., access dysfunction or progressive stenosis), operative findings, details of the anastomotic revision, anesthesia type, estimated blood loss, and postoperative instructions for dialysis scheduling and access monitoring.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when only the physician’s professional portion is reported separate from the technical component (rare for this surgical service).
`57`	Decision for surgery	Data not available in the input.
`50`	Bilateral procedure	Use when both upper-extremity fistulas are revised in the same operative session (apply modifier per payer rules).
`51`	Multiple procedures	Use when this code is reported in addition to other distinct procedures performed during the same operative session.
`52`	Reduced services	Use when the surgeon elects to perform a reduced or incomplete revision.
`53`	Discontinued procedure	Use when the procedure is started but discontinued for extenuating circumstances.
`59`	Distinct procedural service	Use to indicate a distinct procedural service unrelated to other services on the same day (avoid when anatomic adjacencies are related).
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions of the revision.
`78`	Unplanned return to OR	Use when the patient returns to the operating room for a related procedure during the postoperative period for complications of the initial revision.
`79`	Unrelated procedure or service	Use when a separate unrelated procedure is performed during the postoperative period.

Taxonomy Code	Specialty	Notes
Data not available in the input.	Vascular Surgery	Vascular surgeons most commonly perform arteriovenous fistula revisions.
Data not available in the input.	General Surgery (with vascular expertise)	General surgeons with vascular experience perform this procedure in some centers.
Data not available in the input.	Interventional Nephrology	Some nephrologists with surgical training perform access revisions.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I77.6`	Arteriovenous fistula, acquired	Directly describes acquired arteriovenous fistulas used for dialysis access that may require surgical revision.
`N18.6`	End stage renal disease	Underlying condition necessitating durable vascular access for hemodialysis; common indication for fistula revision.
`I80.9`	Phlebitis and thrombophlebitis of unspecified site	Relevant when venous inflammation or thrombosis contributes to access dysfunction (note: `36832` excludes thrombectomy).
`T82.898A`	Other complications of vascular prosthetic devices, implants and grafts, initial encounter	Used when prior synthetic graft complications contribute to the need for revision.
`I74.9`	Arterial embolism and thrombosis of unspecified site	Included when arterial inflow problems affect fistula function; typically requires vascular evaluation.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36833`	Thrombectomy, open, thrombosed arteriovenous fistula, with revision of the anastomosis	Performed when thrombus is present and requires removal in addition to anastomotic revision; differs because `36832` specifies no thrombectomy.
`36818`	Creation of arteriovenous fistula; upper arm autogenous/synthetic (brachiocephalic, brachiobasilic)	Performed when a new or alternate permanent access is created if revision is not feasible or fails.
`36901`	Insertion of tunneled dialysis catheter, non-tunneled or tunneled, with cuff	Used when immediate dialysis access is required and the fistula revision will not provide timely access.
`37225`	Transcatheter placement of intravascular stent(s), any vessel; initial vessel	Endovascular interventions such as angioplasty/stenting may be performed adjunctively for outflow stenosis identified intraoperatively or in staged endovascular procedures.
`99140`	Anesthesia for procedures on major vessels of the extremities	Anesthesia codes may be reported as appropriate for regional or monitored anesthesia care documented during the revision.