Transcript Vascular Mapping

Vascular Mapping
ASDIN Coding University
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Two Approaches to Coding
• There are 2 different ways to code vascular mapping for
vascular access placement
• The approach used depends upon the patient’s situation
related to previous access placement
1. If the patient has not had a previous fistula or graft,
the temporary code G0365 should be used
2. If the patient has had a prior arteriovenous dialysis
access (graft or fistula) component coding should be
used
• The choice of approach is not discretionary
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G0365
• G0365 should be used if the patient has not had a
previous fistula or graft
• The descriptor for this code is - mapping of vessel for
hemodialysis access (services for preoperative vessel
mapping prior to creation of hemodialysis access
using an autogenous hemodialysis conduit, including
arterial inflow and venous outflow)
• This code is for 1 extremity only, if both extremities
are examined, use a 59 modifier on the second code
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Requirements for G0365
• The code G0365 covers imaging that is performed
using any technique or combination of techniques
• It should be noted that the descriptor for this code
specifies that both the venous and arterial anatomy
must be evaluated
• If only the veins are imaged, a 52 modifier should be
attached to the code to indicate a reduced level of
service
• G0365 can only be used two times per year
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Using Other Codes with G0365
• The use of G0365 does not preclude the use of
surgical codes that might be warranted based upon
the type of procedure performed
• If the vein mapping portion of the study is
performed by angiography, the code 36005
(cannulation of vein and injection of contrast) may
be recorded
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If Both Angiography and US Are Used
• There are two approaches that are commonly used
for doing this procedure:
1. Ultrasound only
2. Both Ultrasound and angiography (bimodal study)
• Regardless of the approach, the only code that
would be appropriate is G0365, 36005 can also be
recorded if vein cannulation is required
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Case With Prior AV Access
• In the case of a patient who has had a prior
arteriovenous dialysis access (graft or fistula),
component coding should be done
• There are two approaches that are commonly used
for doing this procedure:
1. Ultrasound only
2. Both Ultrasound and angiography (bimodal study)
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Ultrasound Only
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Arterial Ultrasound
• The codes for performing ultrasound studies on the
artery are 93931 if unilateral and 93930 if bilateral
• The descriptor for 93931– duplex scan of the upper
extremity arteries or arterial bypass grafts; unilateral
or limited study
• The descriptor for 39330– duplex scan of the upper
extremity arteries or arterial bypass grafts; complete
bilateral study
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Venous Ultrasound
• The codes for performing ultrasound studies on the
vein are 93971 if unilateral and 93970 if bilateral
• The descriptor for 93971 - duplex scan of the upper
extremity veins including compression and other
maneuvers; unilateral or limited study
• The descriptor for 93970 – duplex scan of the upper
extremity veins including compression and other
maneuvers; complete bilateral study
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Duplex Ultrasound
• It should be noted that the descriptor for both
arterial and venous ultrasound states that the code
is for duplex ultrasound
• Duplex ultrasound – combines Doppler flow
information and conventional imaging information
(B-mode)
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Bimodal Study
Ultrasound and Angiography
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Arterial Portion of Study
• This portion of the study is generally done by
ultrasound only
• This should be coded in the same manner as if only
this modality was being done
– 93931 – unilateral arterial study
– 93930 – bilateral arterial study
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Venous Portion of the Study
• With this approach to vascular mapping the veins
are generally examined with both ultrasound and
angiography
• Even though a vessel is imaged using multiple
modalities, only one can be coded for that date
• When both ultrasound and angiography is
performed, the angiogram represents a higher level
code and should be the one recorded
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Cannulation and Injection of Contrast
• The code for this procedure is 36005
• The descriptor for this code is - injection procedure
for contrast venography (including introduction of
needle or intracatheter)
• This code’s use is restricted to non-access, vein
cannulation as with the performance of a venogram
• If the study is bilateral, then the code would be used
a second time with the -59 modifier
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Venogram
• The codes for angiographic visualization of the vein are
75820 (unilateral) and 75822 (bilateral)
• The descriptor for 75820 is – venography, extremity,
unilateral, radiological supervision and interpretation
• The descriptor for 75822 is - venography, extremity,
bilateral, radiological supervision and interpretation
• In both instances the code covers all venous structures
up to but not including the superior vena cava
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Superior Vena Cava Angiogram
• The code for study of the superior vena cava is 75827
• The descriptor for this is - venography caval, superior,
with serialography, radiological supervision and
interpretation
• If 75827 is recorded, one should be sure that the
superior vena cava was clearly demonstrated in detail, it
should be a complete study
• Additionally, the medical indication for a complete study
should be clearly documented
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Total List of Codes
• The list of codes for a unilateral bimodal study:
– 93931 – Ultrasound of artery (unilateral)
– 36005 – cannulation of vein and radiocontrast injection
– 75820 – venogram of arm (unilateral)
– 75827 – venogram of SVC (if complete study performed)
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Important Note
• This document is for informational purposes only and
should serve as a guideline for appropriate coding.
• The ultimate responsibility for correct coding
/documentation remains with the provider of service.
• ASDIN makes no representation, warranty, or guarantee
that this compilation of information is error-free, nor
that the use of this guide will prevent differences of
opinion or disputes with CMS or any other carrier.
• ASDIN will bear no responsibility or liability for the
results or consequences that may grow out of the use of
this guidance.
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