How To Use CPT Code 36818

CPT 36818 describes the creation of an arteriovenous anastomosis by connecting the cephalic vein to the brachial artery in the upper arm. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 36818?

CPT 36818 is used to describe the procedure in which a healthcare provider creates an arteriovenous anastomosis by connecting the cephalic vein to the brachial artery in the upper arm. This procedure is performed to improve vascular access in patients with kidney failure who will undergo hemodialysis treatment. It involves making two incisions in the arm, creating a subcutaneous tunnel between the incisions, dissecting a portion of the cephalic vein, and connecting it with the brachial artery. The provider then sutures the soft tissues to close the wound.

2. Official Description

The official description of CPT code 36818 is: ‘Arteriovenous anastomosis, open; by upper arm cephalic vein transposition.’

3. Procedure

1. The healthcare provider makes two incisions in the upper arm, one over the cephalic vein and another over the brachial artery.
2. A subcutaneous tunnel is created between the two incisions.
3. A portion of the cephalic vein is dissected and pulled through the tunnel to connect it with the brachial artery.
4. All bleeding is stopped, and the wound is closed by suturing the soft tissues in layers.

4. Qualifying circumstances

CPT 36818 is performed in patients with kidney failure who require hemodialysis treatment. It is used to create a better vascular access for hemodialysis by connecting the cephalic vein to the brachial artery in the upper arm. This procedure should not be reported in conjunction with other codes such as 36819, 36820, 36821, or 36830 during a unilateral upper extremity procedure. Modifier 50 or 59 may be used for bilateral upper extremity open arteriovenous anastomoses performed at the same operative session.

5. When to use CPT code 36818

CPT code 36818 should be used when a healthcare provider performs an open arteriovenous anastomosis by connecting the cephalic vein to the brachial artery in the upper arm. This procedure is specifically used for patients with kidney failure who require hemodialysis treatment. It should not be used in conjunction with other codes for unilateral upper extremity procedures, unless bilateral upper extremity open arteriovenous anastomoses are performed at the same operative session.

6. Documentation requirements

To support a claim for CPT 36818, the healthcare provider must document the following information:

• Patient’s diagnosis of kidney failure and the need for hemodialysis treatment
• Specific details of the procedure, including the connection of the cephalic vein to the brachial artery
• Date of the procedure
• Any additional information relevant to the procedure
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 36818, ensure that the procedure is performed by a qualified healthcare provider and that it involves the connection of the cephalic vein to the brachial artery in the upper arm. It should not be reported in conjunction with other codes for unilateral upper extremity procedures, unless bilateral upper extremity open arteriovenous anastomoses are performed at the same operative session. Modifier 50 or 59 may be used in such cases.

8. Historical information

CPT 36818 was added to the Current Procedural Terminology system on January 1, 2005. There have been no updates to the code since its addition.

9. Examples

1. A healthcare provider creates an arteriovenous anastomosis by connecting the cephalic vein to the brachial artery in the upper arm to improve vascular access for hemodialysis in a patient with kidney failure.
2. During a surgical procedure, a provider performs an open arteriovenous anastomosis by connecting the cephalic vein to the brachial artery in the upper arm to facilitate hemodialysis treatment in a patient with end-stage renal disease.
3. A patient with kidney failure undergoes a procedure in which the cephalic vein is transposed and connected to the brachial artery in the upper arm to create an arteriovenous anastomosis for hemodialysis access.
4. A healthcare provider performs an open arteriovenous anastomosis by connecting the cephalic vein to the brachial artery in the upper arm to establish a reliable vascular access for hemodialysis in a patient with chronic kidney disease.
5. During a surgical intervention, a provider creates an arteriovenous anastomosis by connecting the cephalic vein to the brachial artery in the upper arm to enable effective hemodialysis treatment in a patient with renal insufficiency.
6. A patient with kidney failure undergoes a procedure in which the cephalic vein is transposed and anastomosed to the brachial artery in the upper arm to establish a functional vascular access for hemodialysis.
7. A healthcare provider performs an open arteriovenous anastomosis by connecting the cephalic vein to the brachial artery in the upper arm to provide a suitable access point for hemodialysis in a patient with end-stage renal disease.