This code replaces code 75558, 75560, 75562, 75564 which described cardiac MRI with flow/velocity quantification. Code 75565 is reported when flow velocity measurements are documented during a cardiac MRI.
Dialysis Access Maintenance: Codes 36145 and 75790 have been deleted and replaced with 3 new codes describing access into an AV fistula and imaging of the fistula.
36147 Introduction of needle and/or catheter, AV shunt created for dialysis (graft/fistula); initial access w/ complete radiological evaluation of dialysis access, including fluoroscopy, image documentation and report (includes access of shunt, injection(s) of contrast, and all necessary imaging from the arterial anastomosis and adjacent artery through the entire venous outflow including the IVC or SVC)
(If 36147 indicates need for a therapeutic intervention requiring a second catheterization of the shunt, use 36148 (Do not report 36147 in conjunction with 75791)
Code 36147 is a combination code that replaces codes 36145 and 75790. Rather than reporting access (36145) and imaging of the fistula (75790) separately, code 36147 now includes both the access and the imaging of the AV graft and should be the only code reported when a fistulagram is performed via a direct puncture into the AV graft.
36148 addl access for therapeutic intervention (List separately in addition to code for primary procedure. (Use 36148 in conjunction with 36147)
Code 36148 is used to describe when an angioplasty, atherectomy, stent or thrombectomy, etc. necessitates a second puncture directly into the AV graft to perform the necessary therapeutic intervention.
75791 Angiography, AV shunt (eg, dialysis patient fistula/graft), complete evaluation of dialysis access, including fluoroscopy, image documentation and report (includes injections of contrast and all necessary imaging from the arterial anastomosis and adjacent artery through the entire venous outflow including the IVC or SVC), radiological supervision and interpretation
(For introduction of catheter, if necessary, see 36140, 36215-36217, 36245-36247)
(Use 75791 only if radiological evaluation is performed through an already existing access into the shunt or from an access that is not a direct puncture of the shunt)
(For radiological evaluation with needle/catheter introduction, AV dialysis shunt, complete procedure, use 36147).
Code 75791 was added to describe those rare instances in which imaging of the AV fistula may occur via an existing access or from a catheter position other than a direct puncture into the graft. This code should never be used when a fistulagram is performed through a fresh, direct puncture into the AV graft.
It is also important to note that HCPCS codes G0392 Transluminal balloon angioplasty, percutaneous; for maintenance of hemodialysis access, arteriovenous fistula or graft; arterial and G0393 Transluminal balloon angioplasty, percutaneous; for maintenance of hemodialysis access, arteriovenous fistula or graft; venous have been deleted for 2010. Angioplasty of the AV graft should be reported using the venous PTA code (35476) or the arterial PTA code (35475) as appropriate.