How To Use CPT Code 36821

CPT 36821 describes the creation of an arteriovenous anastomosis, specifically a direct connection between a vein and an artery at any site in the body. 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 36821?

CPT 36821 is used to describe the procedure of creating an arteriovenous anastomosis, where a vein is connected directly to an artery at any location in the body. This procedure is performed to improve vascular access in patients with kidney failure who require hemodialysis treatments. The arteriovenous anastomosis allows for increased blood flow through the vein, facilitating the process of hemodialysis.

2. Official Description

The official description of CPT code 36821 is: ‘Arteriovenous anastomosis, open; direct, any site (eg, Cimino type) (separate procedure).’ This code specifically refers to the creation of a direct connection between a vein and an artery at any location in the body, such as the Cimino-type anastomosis that connects the cephalic vein to the radial artery at the wrist.

3. Procedure

1. The procedure begins with the patient being appropriately prepped and anesthetized.
2. The provider makes an incision in the skin over the vein and artery at the desired site.
3. The vein is dissected free and prepared for connection to the artery.
4. The downstream portion of the vein is sutured to the adjacent artery in a direct side-to-side fashion, creating the arteriovenous anastomosis.
5. All bleeding is stopped, and the wound is closed by suturing the soft tissues in layers.

4. Qualifying circumstances

CPT 36821 is performed in patients with kidney failure who require hemodialysis treatments. The procedure is indicated when there is a need for improved vascular access to facilitate hemodialysis. The patient must have an established diagnosis of kidney failure and be deemed suitable for the creation of an arteriovenous anastomosis. The procedure is typically performed by a qualified healthcare professional with expertise in vascular access procedures.

5. When to use CPT code 36821

CPT code 36821 should be used when a direct arteriovenous anastomosis is created at any site in the body. This code is appropriate for reporting the procedure when performed as a separate procedure. It is important to note that CPT code 36821 should not be reported if the procedure is performed as part of another surgical procedure.

6. Documentation requirements

To support a claim for CPT code 36821, the healthcare professional must document the following information:

• Patient’s diagnosis of kidney failure
• Location of the arteriovenous anastomosis
• Date of the procedure
• Details of the procedure, including the incision, dissection, suturing, and closure
• Any complications or additional procedures performed
• Signature of the healthcare professional performing the procedure

7. Billing guidelines

When billing for CPT code 36821, ensure that the procedure is performed as a separate procedure and not as part of another surgical procedure. It is important to use the appropriate documentation to support the claim. Additionally, be aware of any specific payer guidelines or requirements for reporting this code.

8. Historical information

CPT code 36821 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A surgeon creates a direct arteriovenous anastomosis between the basilic vein and the brachial artery in the upper arm to improve vascular access for hemodialysis in a patient with kidney failure.
2. A vascular specialist performs a Cimino-type arteriovenous anastomosis, connecting the cephalic vein to the radial artery at the wrist, to facilitate hemodialysis in a patient with end-stage renal disease.
3. An interventional radiologist creates an arteriovenous anastomosis between the femoral vein and the femoral artery in a patient with kidney failure who requires hemodialysis.
4. A vascular surgeon performs an arteriovenous anastomosis by forearm vein transposition to establish vascular access for hemodialysis in a patient with end-stage renal disease.
5. A nephrologist creates an arteriovenous anastomosis between the brachial artery and the cephalic vein in the upper arm to provide improved vascular access for hemodialysis in a patient with kidney failure.
6. A vascular surgeon performs a direct arteriovenous anastomosis between the radial artery and the cephalic vein in the forearm to facilitate hemodialysis in a patient with end-stage renal disease.
7. An interventional radiologist creates an arteriovenous anastomosis between the popliteal vein and the popliteal artery in a patient with kidney failure who requires hemodialysis.
8. A vascular specialist performs a Cimino-type arteriovenous anastomosis, connecting the basilic vein to the brachial artery in the upper arm, to improve vascular access for hemodialysis in a patient with end-stage renal disease.
9. A surgeon creates an arteriovenous anastomosis between the subclavian vein and the subclavian artery to establish vascular access for hemodialysis in a patient with kidney failure.
10. An interventional radiologist performs a direct arteriovenous anastomosis between the ulnar artery and the ulnar vein in the forearm to facilitate hemodialysis in a patient with end-stage renal disease.