How To Use CPT Code 36819

CPT 36819 describes the creation of an arteriovenous anastomosis by connecting the basilic 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 36819?

CPT 36819 is used to describe the procedure in which a healthcare provider creates an arteriovenous anastomosis by connecting the basilic 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, one over the basilic vein and another over the brachial artery. The provider then creates a tunnel between the two incisions and connects the basilic vein to the brachial artery. The procedure is completed by suturing the soft tissues in layers to close the wound.

2. Official Description

The official description of CPT code 36819 is: ‘Arteriovenous anastomosis, open; by upper arm basilic vein transposition.’ It is important to note that CPT code 36819 should not be reported in conjunction with codes 36818, 36820, 36821, or 36830 during a unilateral upper extremity procedure. If bilateral upper extremity open arteriovenous anastomoses are performed at the same operative session, modifier 50 or 59 should be used as appropriate.

3. Procedure

1. The healthcare provider prepares the patient for the procedure and ensures they are appropriately prepped and anesthetized.
2. The provider makes two incisions in the arm, one over the basilic vein and another over the brachial artery.
3. A tunnel is created between the two incisions.
4. A portion of the basilic vein is dissected and pulled through the tunnel to connect it with the brachial artery.
5. All bleeding is stopped, and the wound is closed by suturing the soft tissues in layers.

4. Qualifying circumstances

CPT 36819 is performed in patients with kidney failure who require hemodialysis treatment. It is used to create an arteriovenous anastomosis to provide better vascular access for the dialysis procedure. The procedure involves connecting the basilic vein to the brachial artery in the upper arm. It should not be reported with other codes such as 36818, 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 36819

CPT code 36819 should be used when a healthcare provider performs the procedure to create an arteriovenous anastomosis by connecting the basilic vein to the brachial artery in the upper arm. It is specifically used for patients with kidney failure who require hemodialysis treatment. It should not be reported with other codes during a unilateral upper extremity procedure, unless bilateral upper extremity open arteriovenous anastomoses are performed at the same operative session, in which case modifier 50 or 59 should be used.

6. Documentation requirements

To support a claim for CPT 36819, the healthcare provider must document the following information:

• Patient’s diagnosis of kidney failure and the need for hemodialysis treatment
• Details of the procedure, including the connection of the basilic vein to the brachial artery in the upper arm
• Date of the procedure
• Any additional information relevant to the specific case

7. Billing guidelines

When billing for CPT 36819, it is important to ensure that the procedure is performed by a qualified healthcare provider and that it involves the connection of the basilic vein to the brachial artery in the upper arm. It should not be reported with other codes during a unilateral upper extremity procedure, unless bilateral upper extremity open arteriovenous anastomoses are performed at the same operative session, in which case modifier 50 or 59 should be used as appropriate.

8. Historical information

CPT 36819 was added to the Current Procedural Terminology system on January 1, 2000. There have been historical changes to the code, including a code change on January 1, 2002, when it was modified to specify upper arm basilic vein transposition.

9. Examples

1. A healthcare provider performs CPT 36819 to create an arteriovenous anastomosis by connecting the basilic vein to the brachial artery in the upper arm for a patient with kidney failure who requires hemodialysis treatment.
2. During a surgical procedure, a provider uses CPT 36819 to create an arteriovenous anastomosis in the upper arm to improve vascular access for a patient undergoing hemodialysis.
3. A patient with kidney failure undergoes CPT 36819 to have an arteriovenous anastomosis created by connecting the basilic vein to the brachial artery in the upper arm to facilitate hemodialysis treatment.
4. A healthcare provider performs CPT 36819 to create an arteriovenous anastomosis in the upper arm for a patient with kidney failure who will undergo hemodialysis.