There are three standard secondary open AV access procedures. CPT code 36831 describes operative thrombectomy of an AV access with no revision to the circuit. CPT code 36832 describes revision of an AV access without thrombectomy. This typically involves venous outflow patch angioplasty or jump grafting. Ligation of fistula side branches at a separate setting, mid-access aneurysm/pseudoaneurysm repair, the second stage of a basilic vein transposition, or proximalization of arterial inflow qualifies as well. Lastly, CPT code 36833 describes thrombectomy of an occluded AV access and subsequent revision using open techniques in the same setting. Completion angiography after open arterial or venous surgery is bundled into the procedure. However, preoperative contrast imaging on the same day as the open dialysis may be reported with a -59 modifier appended to the radiologic coding. These surgery descriptions have a 90-day global period associated with them as well and realized a significant increase in RVU content in 2015 due to the reassessment of all open AV access surgeries.

Two additional open procedure codes should be mentioned. CPT code 37607 depicts either AV access banding to limit flow through the hemodialysis circuit or ligation of the AV access in its entirety to completely obliterate flow. CPT code 36838 describes a secondary procedure code that is sometimes employed in those patients who have developed steal syndrome. To maintain patency of an autogenous access while helping with limb salvage, the distal revascularization and interval ligation (DRIL) procedure may be employed, which includes ligation of the brachial artery distal to the AV access arterial anastomosis, vein harvest, and remote brachial to brachial artery bypass. CPT code 36838 describes such an intervention in the upper extremity and cannot be reported for treatment of steal syndrome in the lower extremity. The RVU content for these five secondary procedures is listed in Table 5.2.