How To Use CPT Code 36838

CPT 36838 describes a surgical procedure known as distal revascularization and interval ligation (DRIL) for upper extremity hemodialysis access, specifically for the treatment of steal syndrome. This article will cover the official description, procedure details, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 36838?

CPT 36838 is a code used to describe a surgical procedure called distal revascularization and interval ligation (DRIL) for upper extremity hemodialysis access. This procedure is performed to correct dialysis access-induced ischemia, also known as steal syndrome. The aim of the procedure is to restore blood supply to the hand while preserving the access site.

2. Official Description

The official description of CPT code 36838 is: ‘Distal revascularization and interval ligation (DRIL), upper extremity hemodialysis access (steal syndrome).’ It is important to note that CPT code 36838 should not be reported in conjunction with codes 35512, 35522, 35523, 36832, 37607, or 37618.

3. Procedure

1. In this surgical procedure, the provider begins by exploring the hemodialysis access site in the patient’s upper extremity.
2. A vein bypass graft, or vein, is harvested from another location in the patient’s body.
3. The provider then uses the vein graft to increase blood supply to the arteries of the lower arm.
4. The vein graft is carried from a portion of the upper arm, above the hemodialysis fistula, and joined to the artery below the access site for hemodialysis.
5. This restores blood supply to the hand.
6. In addition to the revascularization procedure, the provider performs ligation by segregating and binding a part of a brachial artery between the distal joining of the bypass graft and the hemodialysis fistula location.
7. The purpose of ligation is to ensure an appropriate vascular supply to the lower portion of the upper extremity without interrupting the blood flow to the site of hemodialysis access.

4. Qualifying circumstances

CPT 36838 is performed on patients who have developed steal syndrome, a condition where the hemodialysis access site causes ischemia in the lower part of the upper extremity. The procedure is intended to restore blood supply to the hand while preserving the access site. It is important to note that CPT code 36838 should not be reported in conjunction with codes 35512, 35522, 35523, 36832, 37607, or 37618.

5. When to use CPT code 36838

CPT code 36838 should be used when performing the DRIL procedure for upper extremity hemodialysis access in patients with steal syndrome. It is important to ensure that the procedure is not being performed in conjunction with other specific codes, as mentioned in the official description.

6. Documentation requirements

To support a claim for CPT code 36838, the provider must document the following information:

• Patient’s diagnosis of steal syndrome and the need for the DRIL procedure
• Details of the procedure, including the exploration of the hemodialysis access site, vein bypass grafting, and ligation
• Date of the procedure
• Any complications or additional procedures performed
• Signature of the provider

7. Billing guidelines

When billing for CPT code 36838, it is important to ensure that the procedure is not being reported in conjunction with codes 35512, 35522, 35523, 36832, 37607, or 37618. These codes are not to be reported together with CPT code 36838. It is important to follow the specific guidelines provided by the payer to ensure accurate billing and reimbursement.

8. Historical information

CPT code 36838 was added to the Current Procedural Terminology system on January 1, 2004. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient with steal syndrome undergoes the DRIL procedure to restore blood supply to the hand and preserve the hemodialysis access site.
2. A provider performs the DRIL procedure on a patient with upper extremity hemodialysis access-induced ischemia, ensuring appropriate blood flow to the hand.
3. A patient with steal syndrome undergoes the DRIL procedure to alleviate symptoms and improve blood supply to the hand.
4. A provider performs the DRIL procedure on a patient with dialysis access-induced ischemia, successfully restoring blood flow to the hand.
5. A patient with steal syndrome undergoes the DRIL procedure to address the hemodialysis access-related ischemia and improve overall vascular supply.
6. A provider performs the DRIL procedure on a patient with upper extremity hemodialysis access, effectively resolving steal syndrome and preserving the access site.
7. A patient with steal syndrome undergoes the DRIL procedure to restore blood flow to the hand and alleviate symptoms.
8. A provider performs the DRIL procedure on a patient with dialysis access-induced ischemia, successfully improving blood supply to the hand.
9. A patient with steal syndrome undergoes the DRIL procedure to address the hemodialysis access-related ischemia and improve overall vascular supply.
10. A provider performs the DRIL procedure on a patient with upper extremity hemodialysis access, effectively resolving steal syndrome and preserving the access site.