2. Ultrasound Examination of Access ASDSIN Coding University 1

3. 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) 2

4. 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 3

5. 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 4

6. 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 5

7. +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 6

8. 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 7

9. 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.