How To Use CPT Code 36833

CPT 36833 describes the surgical procedure of revising an arteriovenous fistula and performing a thrombectomy on an autogenous or nonautogenous dialysis graft. 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 36833?

CPT 36833 is a code used to describe a surgical procedure that involves the revision of an arteriovenous fistula and the removal of a blood clot, or thrombus, from an autogenous or nonautogenous dialysis graft. This procedure is typically performed to improve the connection between an artery and a vein, which is used for dialysis purposes. It is important to note that CPT 36833 is a separate procedure and cannot be reported with a related procedure performed through the same incision.

2. Official Description

The official description of CPT code 36833 is: ‘Revision, open, arteriovenous fistula; with thrombectomy, autogenous or nonautogenous dialysis graft (separate procedure).’ This code should not be reported with other codes for revision of the dialysis circuit.

3. Procedure

1. During the procedure, the provider surgically opens the arteriovenous fistula and revises the connection between the artery and the vein.
2. An incision is made over the fistula, and the area is dissected free.
3. A clamp is placed over the artery and vein to stop the blood flow.
4. The provider clears the area around the vein or artery and makes an incision across the connection between the artery and the vein.
5. The graft is opened, and the blood clot is removed.
6. The provider repairs the graft at its connection with the artery or vein, and may use a new graft if necessary.
7. The graft is flushed to remove debris and air.
8. The clamp is removed to re-establish blood flow, and the graft is sutured and the wound is closed.

4. Qualifying circumstances

CPT 36833 is performed on patients who require a revision of their arteriovenous fistula and a thrombectomy on their dialysis graft. This procedure is typically performed on patients with advanced, permanent kidney failure who require hemodialysis. The provider may use autogenous or nonautogenous tissue grafts to repair the fistula, depending on the patient’s specific needs.

5. When to use CPT code 36833

CPT code 36833 should be used when a provider performs an open revision of an arteriovenous fistula and performs a thrombectomy on an autogenous or nonautogenous dialysis graft. This code should not be reported with other codes for revision of the dialysis circuit.

6. Documentation requirements

To support a claim for CPT 36833, the provider must document the following information:

• Patient’s diagnosis and the need for revision of the arteriovenous fistula
• Specific details of the procedure performed, including the use of autogenous or nonautogenous grafts
• Date of the procedure
• Start and end time of the procedure
• Any complications or additional procedures performed
• Signature of the provider

7. Billing guidelines

When billing for CPT 36833, ensure that the procedure meets the criteria for this code, including the revision of the arteriovenous fistula and the thrombectomy on the dialysis graft. This code should not be reported with other codes for revision of the dialysis circuit. If the procedure is performed with an unrelated procedure, modifier 59 may need to be appended to CPT 36833 to indicate a distinct procedural service.

8. Historical information

CPT 36833 was added to the Current Procedural Terminology system on January 1, 2001. Prior to that, it was described as ‘Revision, arteriovenous fistula; with thrombectomy, autogenous or nonautogenous dialysis graft (separate procedure).’ There have been no updates to the code since its addition.

9. Examples

1. A surgeon performs a revision of an arteriovenous fistula and a thrombectomy on an autogenous dialysis graft for a patient with end-stage renal disease.
2. A vascular specialist performs a revision of an arteriovenous fistula and a thrombectomy on a nonautogenous dialysis graft for a patient with chronic kidney disease.
3. An interventional radiologist performs a revision of an arteriovenous fistula and a thrombectomy on an autogenous dialysis graft for a patient with renal failure.
4. A general surgeon performs a revision of an arteriovenous fistula and a thrombectomy on a nonautogenous dialysis graft for a patient with kidney dysfunction.
5. A vascular surgeon performs a revision of an arteriovenous fistula and a thrombectomy on an autogenous dialysis graft for a patient with dialysis-dependent renal disease.
6. An interventional cardiologist performs a revision of an arteriovenous fistula and a thrombectomy on a nonautogenous dialysis graft for a patient with kidney failure.