2. Vascular Mapping ASDIN Coding University 1

3. 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 2

4. 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 3

5. 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 4

6. 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 5

7. 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 6

8. 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) 7

9. Ultrasound Only 8

10. 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 9

11. 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 10

12. 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) 11

13. Bimodal Study Ultrasound and Angiography 12

14. 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 13

15. 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 14

16. 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 15

17. 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 16

18. 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 17

19. 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) 18

20. 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. 19