Navigating the complexities of interventional radiology coding in 2025 is more challenging than ever, with the threat of evolving guidelines, bundling restrictions, and payer scrutiny adding barriers of difficulty for coders. The percutaneous creation of an arteriovenous fistula (AVF), captured by CPT® codes 36836 and 36837, is a critical procedure for hemodialysis patients, yet coding it correctly requires careful attention to included services and exclusionary rules. Even small missteps in documentation and code selection can have significant financial and compliance consequences. This month we down the nuances of AVF coding complete with a case example, equipping you with the knowledge needed to navigate these harsh realities and ensure accuracy in your coding practices for 2025 and beyond.
When reporting hemodialysis access, codes 36836 and 36837 cover the creation of a percutaneous arteriovenous (AV) fistula in the upper extremity. These codes detail a minimally invasive procedure where a peripheral artery and vein are accessed using image guidance—either through a single access site (36836) or two separate sites (36837). Once the vessels are approximated, energy (such as thermal) is applied to create the fistulous connection.
To ensure the fistula functions properly, maturation procedures may be necessary. This could involve techniques like angioplasty to enhance blood flow or coil embolization to redirect it. The bundling of codes continues to be a pitfall for many coders. There is a temptation to report certain elements separately but without checking properly, this could lead to incorrect code selection. When reporting 36836 or 36837, keep in mind that all aspects of the procedure—including vascular access, angiography, imaging guidance, and any necessary flow redirection—are bundled into these codes. That means additional services like balloon angioplasty or coil embolization performed during the same session cannot be reported separately.
36836 Percutaneous arteriovenous fistula creation, upper extremity, single access of both the peripheral artery and peripheral vein, including fistula maturation procedures (e.g., transluminal balloon angioplasty, coil embolization) when performed, including all vascular access, imaging guidance, and radiologic supervision and interpretation.
36837 Percutaneous arteriovenous fistula creation, upper extremity, separate access sites of the peripheral artery and peripheral vein, including fistula maturation procedures (e.g., transluminal balloon angioplasty, coil embolization) when performed, including all vascular access, imaging guidance, and radiologic supervision and interpretation.
There are a series codes that cannot be reporting with either of the above codes. Do not report 36836 or 36837 in conjunction with 36005, 36140, 36215, 36216, 36217, 36218, 36245, 36246, 36247, 36837, 36901, 36902, 36903, 36904, 36905, 36906, 36907, 36908, 36909, 37236, 37238, 37241, 37242, 37246, 37248, 37252, 75710, 75716, 75820, 75822, 75894, 75898, 76937, 77001.
For arteriovenous fistula creation via an open approach, see 36800, 36810, 36815, 36818, 36819, 36820, 36821. When reporting percutaneous arteriovenous fistula creation in any location other than the upper extremity, use 37799.
Antibiotics were given. Time-out was called. The patient was identified. I prepped and draped the right groin and thigh. I punctured the venous limb of the thigh loop Gore-Tex graft antegrade and put a Nitrex wire through the graft under fluoro into the iliac vein on the right. I then put in a 4-French sheath and did a venogram. There was thrombus in the graft. I upsized to a 7-French sheath and then used the Cleaner mechanical apparatus and did mechanical thrombectomy of the venous outflow tract, which was very easy to do. I also sucked several times thrombus out of the 7-French sheath.
I then did a venogram, which showed a tight stenosis at the venous anastomosis of the Gore-Tex graft. I then put in a 0.018 wire and easily deployed a 7 x 50 Viabahn stent through this anastomotic stricture. I post-dilated with a #7 balloon. There was no waste. I then turned my attention to the arterial side of the limb and punctured it retrograde again out towards the distal curve of the graft. I put a Nitrex wire into the femoral artery. I infused a total of 8 mg of TPA in the graft, then used the Cleaner apparatus and cleaned the graft through the arterial inflow limb. After that was done, I had a palpable pulse in the AV graft despite having the two 7-French sheaths still in place.
36906 Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural pharmacological thrombolytic injection(s); with transcatheter placement of intravascular stent(s), peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the stenting, and all angioplasty within the peripheral dialysis circuit.
All of the work of this procedure is encompassed in code 36906. This code includes the diagnostic fistulagram/venogram, including punctures of both venous and arterial limbs, mechanical thrombectomy, and stent placement at the venous anastomosis. Do not report 36901 and/or 36903 separately, as these services are incorporated into 36906.
Your 2025 Coding Remains at Risk: These Are NOT All the Tips and Tricks Necessary for IR Success. With every dollar of reimbursement counting more than ever in the face of payment decline and complex changes, it’s imperative to make sure your CPTcoding is correct and compliant. Master more coding topics and break down the complexity with our 2025 Diagnostic and Therapeutic Dialysis Shunt Interventional Radiology Coding Webcast on March 12, 2025 at 11:00 am CT.
Continuing with our look at areas of coding confusion, let’s today examine pain. According to Medline Plus Magazine from the National Institutes of Health (NIH),
Today’s hot topic takes a look through the leadership lens of guiding your teams through a software transition. In my case currently, it is a
Please log in to your account to comment on this article.
Physician queries are essential for accurate documentation and claims data, but they are increasingly scrutinized by payors, leading to denials and revenue leakage. This webcast, led by industry expert Cheryl Ericson, RN, MS, CCDS, CDIP, provides actionable strategies to craft compliant queries, reduce denials, and enhance revenue integrity. Attendees will gain insights into clinical validation queries, how to avoid common pitfalls, and learn best practices to defend against query denials. Don’t miss this opportunity to refine your query process and protect your organization’s financial health.
Master the complexities of heart failure coding with this expert-led webcast by Emily Montemayor, CCS, CMBCS, COC, CPC, CPMA. Discover strategies to ensure compliance with ICD-10-CM guidelines, documentation integrity, and capture comorbidities like CKD and hypertension. Learn how to resolve coding challenges, improve documentation practices, and submit clean claims to minimize denials and safeguard your organization’s financial health. With practical insights and real-world examples, this session equips you to prevent revenue leakage, enhance compliance, and secure optimal reimbursement—all while supporting better patient outcomes.
Prepare your organization for the 2025 OPPS updates with expert insights from Tiffani Bouchard, CCS, CRCR, a Revenue Integrity Professional with over 30 years of experience. This webcast will address critical challenges in charge capture and coding, providing clarity on APC policies, C-APC packaging, exclusions, and payer-specific requirements. Attendees will learn actionable strategies to ensure compliance, optimize reimbursement, and mitigate risks of claim denials. Gain the knowledge needed to implement updates effectively, educate your team, and maintain seamless revenue cycle operations in the face of evolving OPPS complexities.
Join Beth Wolf, MD, CPC, CCDS, for an in-depth webcast on the FY2025 spinal fusion MS-DRG updates. Discover key changes in DRG classification, understand impacts on documentation and CMI, and learn strategies to ensure compliance.
Dr. Ronald Hirsch dives into the basics of Medicare for clinicians to be successful as utilization review professionals. He’ll break down what Medicare does and doesn’t pay for, what services it provides and how hospitals get paid for providing those services – including both inpatient and outpatient. Learn how claims are prepared and how much patients must pay for their care. By attending our webcast, you will gain a new understanding of these issues and be better equipped to talk to patients, to their medical staff, and to their administrative team.
Hospitals face growing challenges in measuring observation metrics due to inconsistencies in classification, payer policies, and benchmarking practices. Join Tiffany Ferguson, LMSW, CMAC, ACM, and Anuja Mohla, DO, FACP, MBA, ACPA-C, CHCQM-PHYADV as they provide critical insights into refining observation metrics. This webcast will address key issues affecting observation data integrity and offer strategies for improving consistency in reporting. You will learn how to define meaningful metrics, clarify commonly misinterpreted terms, and apply best practices for benchmarking, and gain actionable strategies to enhance observation data reliability, mitigate financial risk, and drive better decision-making.
The 2025 Medicare Physician Fee Schedule brings significant changes to payment rates, coverage, and coding for physician services, impacting practices nationwide. Join Stanley Nachimson, MS., as he provides a comprehensive guide to understanding these updates, offering actionable insights on new Medicare-covered services, revised coding rules, and payment policies effective January 1. Learn how to adapt your practices to maintain compliance, maximize reimbursement, and plan for revenue in 2025. Whether you’re a physician, coder, or financial staff member, this session equips you with the tools to navigate Medicare’s evolving requirements confidently and efficiently.
Dr. Ronald Hirsch provides critical details on the new Medicare Appeal Process for Status Changes for patients whose status changes during their hospital stay. He also delves into other scenarios of hospital patients receiving custodial care or medically unnecessary services where patient notifications may be needed along with the processes necessary to ensure compliance with state and federal guidance.
Copyright © 2025 ICD10monitor. Powered by MedLearn Media.
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
