How To Use CPT Code 36832

CPT 36832 describes the surgical procedure of revising an arteriovenous fistula without thrombectomy, specifically for autogenous or nonautogenous dialysis grafts. 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 36832?

CPT 36832 can be used to describe the surgical revision of an arteriovenous fistula without thrombectomy. This procedure is specifically performed on autogenous or nonautogenous dialysis grafts, which are connections between an artery and a vein used for dialysis purposes. In this procedure, the provider opens the fistula and revises the connection between the artery and the vein, typically located in the upper arm or forearm.

2. Official Description

The official description of CPT code 36832 is: ‘Revision, open, arteriovenous fistula; without thrombectomy, autogenous or nonautogenous dialysis graft (separate procedure).’ This code specifically refers to the surgical revision of an arteriovenous fistula without the removal of a thrombus or blood clot.

3. Procedure

1. The provider begins by making an incision over the arteriovenous fistula and dissecting it free.
2. Next, the provider clamps the artery and vein to stop the blood flow.
3. The area around the vein or artery is cleared, and an incision is made across the connection between the artery and the vein.
4. The provider then repairs the graft at its connection with the artery or vein, potentially using a new graft if necessary.
5. The graft is flushed to remove debris and air, and the clamp is removed to re-establish blood flow.
6. Finally, the provider sutures the graft and closes the wound by suturing the soft tissue in layers.

4. Qualifying circumstances

CPT 36832 is performed on patients who require a revision of their arteriovenous fistula without the need for thrombectomy. This procedure is specifically performed on autogenous or nonautogenous dialysis grafts, which are used for hemodialysis purposes. The provider must ensure that the patient meets the necessary criteria for this procedure and that it is medically necessary.

5. When to use CPT code 36832

CPT code 36832 should be used when a provider performs a surgical revision of an arteriovenous fistula without thrombectomy, specifically for autogenous or nonautogenous dialysis grafts. This code should not be used if the provider performs a thrombectomy or if the procedure involves a different type of graft or fistula.

6. Documentation requirements

To support a claim for CPT 36832, the provider must document the following information:

• Reason for the revision of the arteriovenous fistula
• Details of the procedure, including the specific graft used and any modifications made
• Date of the procedure
• Start and end time of the procedure
• Any complications or additional procedures performed
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 36832, ensure that the procedure meets the specific criteria outlined in the code description. It is important to accurately document the details of the procedure and any associated grafts used. Additionally, be aware of any related procedures that may impact the reporting of CPT 36832. Modifier 59, Distinct Procedural Service, may be necessary if the procedure is performed with an unrelated procedure in an anatomically related region.

8. Historical information

CPT 36832 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 performs a revision of an autogenous arteriovenous fistula without thrombectomy for a patient requiring dialysis.
2. A vascular specialist revises a nonautogenous dialysis graft without thrombectomy for a patient with a malfunctioning arteriovenous fistula.
3. A provider performs a surgical revision of an autogenous arteriovenous fistula without thrombectomy for a patient experiencing complications with their dialysis access.
4. An interventional radiologist revises a nonautogenous dialysis graft without thrombectomy for a patient with a blocked arteriovenous fistula.
5. A surgeon performs a revision of an autogenous arteriovenous fistula without thrombectomy for a patient with a failing dialysis access.
6. A vascular specialist revises a nonautogenous dialysis graft without thrombectomy for a patient with a stenosed arteriovenous fistula.
7. A provider performs a surgical revision of an autogenous arteriovenous fistula without thrombectomy for a patient with an infected dialysis access.
8. An interventional radiologist revises a nonautogenous dialysis graft without thrombectomy for a patient with a dysfunctional arteriovenous fistula.
9. A surgeon performs a revision of an autogenous arteriovenous fistula without thrombectomy for a patient with a thrombosed dialysis access.
10. A vascular specialist revises a nonautogenous dialysis graft without thrombectomy for a patient with a recalcitrant arteriovenous fistula.