As AI is being used for many payers claims, members are reporting an increase in denials for medically necessary procedures.

For an appeal denied CPT 36215 (selective catheterization) and CPT 75710 (diagnostic extremity arteriogram) when billed with CPT 36902 (dialysis access angioplasty), the success of the appeal depends on demonstrating that the catheterization and diagnostic angiography were separate, medically necessary services that are not included in the dialysis access intervention package.

Key Coding Issue

CPT 36902 includes:

• Access into the dialysis circuit
• All catheter manipulations required to perform the intervention
• Completion fistulography/angiography of the dialysis circuit
• Imaging guidance necessary for the angioplasty

Because of these bundled services, payers often deny 36215 and 75710 as integral components of 36902.

When an Appeal May Be Appropriate

You may have grounds for appeal if documentation shows that:

1. Selective Catheterization Was Outside the Dialysis Circuit

If the physician advanced the catheter into a separate arterial territory (e.g., brachial, axillary, subclavian, or distal runoff vessels) to evaluate inflow disease not visualized through routine dialysis access imaging, then 36215 may represent a distinct service.

Your appeal should state:

The selective catheterization was performed beyond the dialysis access circuit to evaluate clinically significant arterial inflow disease affecting access function and treatment planning. This work exceeded the catheter manipulation included in CPT 36902.

2. The Arteriogram Was Diagnostic Rather Than Interventional Guidance

For 75710, establish that:

• The study was performed because of a clinical indication (ischemia, poor inflow, nonmaturation, steal syndrome, pulse deficit, suspected proximal arterial stenosis, etc.).  Medical necessity is required to be successful
• The results were not known from prior imaging.
• The findings influenced management decisions.

Sample language:

The extremity arteriogram was a medically necessary diagnostic study performed to evaluate suspected arterial inflow pathology. The examination was not a completion fistulogram nor imaging inherent to the angioplasty procedure. Findings directly affected treatment decisions and documented pathology outside the dialysis circuit.

Include the operative note, highlighting the support for the use of the code.

Sample Appeal Statement

CPT 36902 includes imaging and catheter manipulation necessary to perform dialysis access angioplasty within the dialysis circuit. In this case, the physician performed selective catheterization of the arterial inflow vessel and a diagnostic extremity arteriogram to evaluate suspected arterial disease outside the dialysis circuit. These services were medically necessary, separately identifiable, and not solely performed to facilitate the angioplasty. Documentation demonstrates independent diagnostic value and clinical decision-making based upon the angiographic findings. Therefore, reimbursement for CPT 36215 and CPT 75710 is requested in addition to CPT 36902.