Summary & Overview
CPT 36835: Arteriovenous Shunt Creation for Hemodialysis Access
CPT code 36835 represents the surgical creation of an arteriovenous shunt—most often an arteriovenous fistula or graft—placed to provide durable vascular access for hemodialysis. This procedure is a critical component of care for patients with advanced kidney failure who require long-term dialysis and has implications for surgical, nephrology, and dialysis delivery systems nationwide. Access type and surgical technique affect subsequent dialysis adequacy, complication risk, and downstream costs.
Key payers considered include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for when and where the procedure is performed, payer coverage considerations, common billing modifiers, and related coding references. The publication outlines national benchmarks where available, highlights relevant policy and reimbursement updates affecting vascular access procedures, and provides operational guidance on common billing and documentation practices. Practical implications for hospital and ambulatory surgical settings—such as site-of-service selection and perioperative resource needs—are summarized to inform coding, billing, and clinical teams tasked with supporting dialysis access placement.
Billing Code Overview
CPT code 36835 describes the surgical creation of an arteriovenous shunt between an artery and a vein. The procedure is most commonly performed to establish permanent vascular access for hemodialysis in patients with end-stage kidney disease. Hemodialysis uses a dialysis machine to remove waste, excess salts, and fluids from the blood and return the cleaned blood to the circulation.
Service type: Surgical vascular access creation
Typical site of service: Hospital operating room or ambulatory surgery center, with perioperative care in inpatient or outpatient surgical settings depending on patient status and institutional practice.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 58-year-old with end-stage renal disease (ESRD) secondary to diabetic nephropathy who requires long-term hemodialysis. The vascular surgeon evaluates the patient preoperatively, confirming suitable arterial and venous anatomy with duplex ultrasound and physical exam. On the day of service, the patient undergoes placement of an arteriovenous (AV) shunt—commonly a radiocephalic or brachiocephalic AV fistula—under regional or general anesthesia in an inpatient or outpatient surgical setting. The procedure involves creation of a direct anastomosis between an artery and vein to provide durable access for repeated hemodialysis sessions. Postoperative workflow includes immediate assessment of thrill and bruit, wound care instructions, and scheduling of follow-up for maturation assessment and potential interventions (e.g., angioplasty) if maturation is inadequate. Typical sites of service are hospital outpatient departments, ambulatory surgical centers, or inpatient operating rooms when comorbidities or inpatient status dictate.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Service not covered by payer-specific value | Rarely used; payer-specific reporting when required by contract |
11 |