How To Use CPT Code 36902

CPT 36902 describes the introduction of needle(s) and/or catheter(s) into the dialysis circuit, along with diagnostic angiography and transluminal balloon angioplasty. 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 36902?

CPT 36902 can be used to describe a procedure in which a healthcare provider introduces a needle and/or catheter into the dialysis circuit. This is done under fluoroscopic guidance to visualize and record images of the entire dialysis circuit. The provider also performs diagnostic angiography to assess the arterial and venous components of the circuit. If an obstruction is found, the provider may perform transluminal balloon angioplasty to open up the narrowed area using a balloon.

2. Official Description

The official description of CPT code 36902 is: ‘Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava, fluoroscopic guidance, radiological supervision and interpretation and image documentation and report; with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty.’

3. Procedure

1. The healthcare provider prepares the patient for the procedure, ensuring they are appropriately prepped and anesthetized.
2. Under fluoroscopic guidance, the provider introduces a needle and/or catheter into the dialysis circuit through the skin over the surgically created connection between an artery and a vein.
3. Contrast material is injected to visualize the circulation throughout the arterial and venous components of the entire dialysis circuit, including the superior and/or inferior vena cava.
4. The provider identifies any narrowing or obstruction in the peripheral segment of the circuit.
5. If an obstruction is found, the provider inserts a balloon through the catheter into the narrowed area and expands the balloon to open up the vessel lumen.
6. The catheter and balloon are then withdrawn, and pressure is applied to the access point to control bleeding.
7. The provider supervises the procedure, documents the images, interprets the findings, and prepares a report.

4. Qualifying circumstances

CPT 36902 is used for patients who require the introduction of needle(s) and/or catheter(s) into the dialysis circuit for diagnostic angiography and transluminal balloon angioplasty. This procedure is typically performed on patients with a dialysis access point, such as an arteriovenous graft, fistula, or anastomosis. The procedure must be performed under fluoroscopic guidance, and the provider must document all necessary imaging, radiological supervision and interpretation, and image documentation and report.

5. When to use CPT code 36902

CPT code 36902 should be used when a healthcare provider performs the introduction of needle(s) and/or catheter(s) into the dialysis circuit, along with diagnostic angiography and transluminal balloon angioplasty. This code should not be reported if other specific codes, such as 36836, 36837, or 36903, are already used for the same session.

6. Documentation requirements

To support a claim for CPT 36902, the healthcare provider must document the following information:

• Patient’s diagnosis and the need for the procedure
• Specific details of the procedure, including the introduction of needle(s) and/or catheter(s), diagnostic angiography, and transluminal balloon angioplasty
• Date and duration of the procedure
• Imaging findings and interpretation
• Any complications or adverse events
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 36902, ensure that the procedure meets the criteria outlined in the official description. Do not report CPT 36902 if other specific codes, such as 36836, 36837, or 36903, are already used for the same session. It is important to follow the guidelines provided by the payer and use appropriate modifiers if necessary.

8. Historical information

CPT 36902 was added to the Current Procedural Terminology system on January 1, 2017. There have been no updates to the code since its addition.

9. Examples

1. A healthcare provider introduces a needle and catheter into the dialysis circuit of a patient with an arteriovenous graft. Diagnostic angiography is performed, and an obstruction is identified. The provider performs transluminal balloon angioplasty to open up the narrowed area.
2. Under fluoroscopic guidance, a healthcare provider introduces a catheter into the dialysis circuit of a patient with an arteriovenous fistula. Diagnostic angiography is performed, and no obstruction is found, so no angioplasty is performed.
3. A patient with an arteriovenous anastomosis undergoes the introduction of needle(s) and catheter(s) into the dialysis circuit. Diagnostic angiography reveals a significant obstruction, and the provider performs transluminal balloon angioplasty to improve blood flow.