Transcript Ultrasound Examination of Access

Ultrasound Examination of Access
ASDSIN Coding University
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Ultrasound Evaluation of Vascular Access
• 93990 is the code for ultrasound evaluation of the
vascular access
• The descriptor for this code is – duplex scan of
hemodialysis access (including arterial inflow, body
of access and venous outflow)
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Required Elements of Study
• This study must include all components of the access
– Arterial inflow
– Body of access
– Venous outflow
• Since the descriptor specifically states “duplex
ultrasound”, the study must also include:
– B-mode
– Spectral Doppler
– Color Doppler
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Using More Than 1 Modality to Image
• Imaging of the same vascular structure by more than one
modality on the same day should not be coded under ordinary
circumstances
• However, if a Doppler flow study demonstrates reduced flow
– Blood flow rate less than 800cc/min, or
– Decreased flow of 25% or greater from previous study
An arteriogram can also be coded if required to further define
the nature and extent of the problem
It is very important in this situation that the patient’s medical
record provide adequate documentation supporting the need
for more than one imaging study
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US to Assist Cannulation
• Ultrasound guidance may be required to assist in
the cannulation of an access
• The code for this procedure is +76937
• The descriptor for this code is – ultrasound guidance
for vascular access requiring ultrasound evaluation
of potential access sites, documentation of selected
vessel patency, concurrent real time ultrasound
visualization of vascular needle entry, with
permanent recording and reporting
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+76937
• +76937 is an add-on code and must be used in
conjunction with another basic code, in this case
36147
• In the 2012 Coding Manual +76937 is listed as a
column 2 code when used with 36147; however,
after the Manual was published, the Column 1/
Column 2 edit was deleted by CMS
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Permanent Image
• All of the ultrasound procedures discussed in this
unit require that a permanent recorded image be
made and placed in the medical record
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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.