Of all the coding areas to approach with caution, cardiology coding remains in the top tier. Cardiology CPT® coding is notoriously complex due to the intricate nature of cardiovascular procedures and the frequent updates to coding guidelines. Unlike many other specialties, cardiology encompasses a wide range of diagnostic and interventional procedures, including cardiac catheterization, electrophysiology studies, echocardiography, and coronary interventions like angioplasty and stenting. Each procedure could involve multiple components—such as imaging, supervision, and interventional techniques—that must be accurately reported. Interventional radiology plays a crucial role in managing arteriovenous (AV) fistulas and grafts for dialysis patients, ensuring proper blood flow and functionality. Understanding the differences between AV fistulas and grafts, as well as the coding nuances for diagnostic and interventional procedures, is essential for accurate medical billing and compliance. Let’s analyze the nuances for actionable answers to create success in 2025 and beyond.
For patients undergoing long-term dialysis, maintaining a reliable vascular access point is essential. This is typically achieved through an arteriovenous (AV) fistula or an AV graft—two distinct but sometimes confused methods. An AV fistula is created by directly connecting a patient’s vein to an artery, promoting natural blood flow and vessel maturation. In contrast, an AV graft involves the use of an artificial tube that bridges a vein and an artery, providing an alternative when a fistula is not feasible. While the arm is the most common location for both, veins and arteries in the thigh may be used if necessary. These access points, often referred to as shunts, serve as the lifeline for dialysis patients, ensuring efficient blood filtration.
When it comes to diagnostic and interventional procedures, understanding the structure of the dialysis circuit is crucial. The circuit extends from the arterial connection (arterial anastomosis) to the heart’s right atrium and consists of two key segments: the peripheral and central dialysis segments. The peripheral segment stretches from the arterial anastomosis through the axillary or cephalic vein, while the central dialysis segment includes the subclavian and innominate veins leading to the superior vena cava. Understanding hierarchies is a critical step to accurate coding. Coding for procedures within the dialysis circuit follows a specific hierarchy under CPT codes 36901–36909, which cover everything from diagnostic imaging to angioplasty, stenting, and embolization. Unlike standard vascular interventions, these codes are tailored specifically for dialysis-related procedures, ensuring precise reporting and compliance.
36901 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;
36902 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
36903 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 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 segment
36904 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);
36905 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 transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty
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
+36907 Transluminal balloon angioplasty, central dialysis segment, performed through dialysis circuit, including all imaging and radiological supervision and interpretation required to perform the angioplasty (List separately in addition to code for primary procedure)
+36908 Transcatheter placement of intravascular stent(s), central dialysis segment, performed through dialysis circuit, including all imaging and radiological supervision and interpretation required to perform the stenting, and all angioplasty in the central dialysis segment (List separately in addition to code for primary procedure)
+36909 Dialysis circuit permanent vascular embolization or occlusion (including main circuit or any accessory veins), endovascular, including all imaging and radiological supervision and interpretation necessary to complete the intervention (List separately in addition to code for primary procedure)
| 36901 | 36902 | 36903 | 36904 | 36905 | 36906 |
| Fistulagram | Fistulagram | Fistulagram | Fistulagram | Fistulagram | Fistulagram |
| Peripheral angioplasty | Peripheral angioplasty (if performed) | Mechanical thrombectomy/ thrombolysis | Mechanical thrombectomy/ thrombolysis | Mechanical thrombectomy/ thrombolysis | |
| Peripheral stent placement | Peripheral angioplasty | Peripheral angioplasty (if performed) | |||
| Peripheral stent placement |
| 36907 | 36908 | 36909 |
| Add-on code | Add-on code | Add-on code |
| Central angioplasty | Central stent placement | Dialysis circuit embolization (includes accessory veins) |
| Use in conjunction with 36901–36906 | ||
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As part of Heart Month, check out Heart Failure Coding Essentials: Ensuring Compliance and Optimal Reimbursement on February 26, 2025, at 12:30 pm CT.
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Accurately determining the principal diagnosis is critical for compliant billing, appropriate reimbursement, and valid quality reporting — yet it remains one of the most subjective and error-prone areas in inpatient coding. In this expert-led session, Cheryl Ericson, RN, MS, CCDS, CDIP, demystifies the complexities of principal diagnosis assignment, bridging the gap between coding rules and clinical reality. Learn how to strengthen your organization’s coding accuracy, reduce denials, and ensure your documentation supports true medical necessity.
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Sepsis remains one of the most frequently denied and contested diagnoses, creating costly revenue loss and compliance risks. In this webcast, Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, provides practical, real-world strategies to align documentation with coding guidelines, reconcile Sepsis-2 and Sepsis-3 definitions, and apply compliant queries. You’ll learn how to identify and address documentation gaps, strengthen provider engagement, and defend diagnoses against payer scrutiny—equipping you to protect reimbursement, improve SOI/ROM capture, and reduce audit vulnerability in this high-risk area.
Only ICD10monitor delivers what you need: updates on must-know changes associated with the FY26 IPPS, including new ICD-10-CM/PCS codes, CCs/MCCs, and MS-DRGs, plus insights, analysis and answers to your questions from two of the country’s most respected subject matter experts.
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Learn how to navigate the proposed elimination of the Inpatient-Only list. Gain strategies to assess admission status, avoid denials, protect compliance, and address impacts across Medicare and non-Medicare payors. Essential insights for hospitals.
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