For the 2023 Current Procedural Terminology (CPT) code set, two new codes (36836 and 36837) have been added that describe percutaneous arteriovenous (AV) fistula creation in the upper extremity. The most significant material difference between these two procedures is that one approach requires two catheters from two different percutaneous access sites, one in the vein and one in the artery that are then approximated using magnets. The other technique requires a single percutaneous access that connects the artery and the vein under ultrasound guidance and then uses mechanical capture for approximation.
Both codes include all vascular access, angiography, imaging guidance, radiologic supervision and interpretation, and blood flow redirection or maturation techniques—for example, transluminal balloon angioplasty or coil embolization—that are performed for fistula creation. Prior to 2023, there were only open surgical codes available for reporting an AV fistula, requiring a surgical cut-down to expose the artery and vein, vein dissection, ligation of venous branches, arteriotomy, and suturing of the vein to the arteriotomy. The coding descriptions for the open access procedures (36818, 36819, 36820, 36821) also include completion ultrasound and completion contrast angiography, if performed.
New codes 36836 and 36837 will have a 0-day global assignment, which means that any services or procedures performed on a day other than the date of the procedure may be separately reported. Surgeons also should keep in mind that percutaneous AV fistula creation in any location other than the upper extremity should be reported with code 37799, Unlisted procedure, vascular surgery.
Sunita Srivastava, MD, is chair and David Han, MD, vice-chair of the Society for Vascular Surgery (SVS) Coding Committee.