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The CPT® Code 76936 refers to the procedure known as ultrasound guided compression repair of an arterial pseudoaneurysm (PSA) or arteriovenous fistulae (AVF). This procedure is particularly relevant in cases following angiography or in patients undergoing dialysis who may experience complications from AVF needle punctures. A pseudoaneurysm is defined as an abnormal, extravascular cavity that fills with blood, which is formed through a channel that connects to the arterial lumen. In contrast, an arteriovenous fistula is a type of shunt that allows blood to flow directly from an artery to a vein, leading to increased diastolic flow in the artery and turbulence in the draining vein. Patients may present with symptoms such as significant pain, bruising, or the formation of a hematoma at the site of the procedure. The ultrasound guided compression technique involves the use of diagnostic ultrasound to evaluate the affected area for any signs of bleeding, to check the patency of the vessel, and to identify the neck of the pseudoaneurysm or the tract of the arteriovenous fistula. During the procedure, a transducer is utilized to apply pressure to the lesion, which is carefully titrated to occlude blood flow within the PSA or AVF while ensuring that adequate blood flow to the artery is maintained. The procedure includes intermittent release of pressure at intervals of 10 to 15 minutes to monitor for thrombosis. The procedure concludes either when successful thrombosis is achieved or if it becomes necessary to terminate the procedure due to inadequate blood flow to the artery or if the patient cannot tolerate the procedure any longer.
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The ultrasound guided compression repair of arterial pseudoaneurysm or arteriovenous fistulae is indicated in specific clinical scenarios, particularly following certain vascular interventions or in patients with established vascular access. The following conditions warrant this procedure:
The ultrasound guided compression repair procedure involves several critical steps to ensure effective treatment of the arterial pseudoaneurysm or arteriovenous fistulae. The following procedural steps are performed:
After the ultrasound guided compression repair, patients may require specific post-procedure care to ensure proper recovery and monitoring. It is essential to observe the site for any signs of complications, such as continued bleeding or hematoma formation. Patients should be monitored for any symptoms indicating inadequate blood flow to the artery, which may necessitate further intervention. Follow-up appointments may be scheduled to assess the success of the procedure and to ensure that the vascular access remains patent and functional. Additionally, patients may receive instructions regarding activity restrictions and signs to watch for that would require immediate medical attention.
| Short Descr | ECHO GUIDE FOR ARTERY REPAIR | Medium Descr | US CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL | Long Descr | Ultrasound guided compression repair of arterial pseudoaneurysm or arteriovenous fistulae (includes diagnostic ultrasound evaluation, compression of lesion and imaging) | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 1 - Diagnostic Tests for Radiology Services | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Procedure or Service, Not Discounted when Multiple | ASC Payment Indicator | Radiology service paid separately when provided integral to a surgical procedure on ASC list; payment based on MPFS nonfacility PE RVUs. | Type of Service (TOS) | 6 - Therapeutic Radiology | Berenson-Eggers TOS (BETOS) | I4B - Imaging/procedure - other | MUE | 1 | CCS Clinical Classification | 197 - Other diagnostic ultrasound |
| 26 | Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number. | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | TC | Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component charges are institutional charges and not billed separately by physicians; however, portable x-ray suppliers only bill for technical component and should utilize modifier tc; the charge data from portable x-ray suppliers will then be used to build customary and prevailing profiles | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | X5 | Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2002-01-01 | Changed | Code description changed. |
| 1995-01-01 | Added | First appearance in code book in 1995. |
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