Alicia: ìWhatís the proper coding to use for ultrasound vein mapping for AVF and AVG
creations for hemodialysis?
The doctor uses ultrasound on the patientís arm while patient is in pre-op holding area
and marks the vasculature on the patientís skin with a marker.
Is this even billable?
Thanks in advance for your assistance.î
Okay, well I did a little research here ...
Alicia: And so what we found here was this article on what upper extremity vein mapping
is, and thatís a link, Laureen.
You can click on that real quick and the article is pretty interesting.
It is long but again, if youíre not familiar with it at all, this is a good place to start.
It breaks it down in each little process and more or less, from a clinicianís point of
view on how to do it.
But again, as a coder, you need to know what theyíre doing so that you can get the best
code.
You might take some time to look thatÖ this is an older article.
Again, if this is 09Ö but it was really, really good.
SoÖ
Laureen: Yeah, not so much for coders, but it does help you get a feel for what theyíre
doing.
Alicia: Right.
And it gives you the verbiage too.
Sometimes, thatís all you need to get in the right direction.
So what are the codes for vein mapping?
These are HCPCS codes for anyone thatís new to coding and arenít as familiar with them.
HCPCS codes arenít talked about as much, and actually not as much in the education
aspect.
Because on the CPC exam, thereís only 5 CPCÖ I mean, the HCPCS questions.
But that doesnít mean you donít need to use it.
But this is a classic example of what you learn once youíre certified and youíre out
in the field.
Youíre going to be using HCPCS more often.
So the code, G0365 is the code for mapping the veins in the extremity for hemodialysis
access.
And that is actually verbatim what the code reads.
I went in and pulled it off the Supercoder to verify.
Okay, now, I am not positive about a code thatís usedÖ a CPT code versus a HCPCS code.
The HCPCS code tells them what is being done.
But I did find this code that is about the access point afterÖ and this is the way I
understand it so you need to verify this, double check it, do your research when youíre
looking into this, because Iím not familiar, but 93990 reads "duplex scan of hemodialysis
access including arterial inflow, body of access and venous outflow".
So what thatís telling me is theyíre doing the duplex of the ultrasound skin and, duplex
just means theyíre doing it in grey and in color.
And theyíre doing the ultrasound skin to verify that the hemodialysis access or that
access where the personís going to have the hemodialysis done is working properly.
Is there good flow intake?
Do we have good movement of the blood so that when we do dialysis, itís going to work?
ThisÖI donít think is the proper code for an ultrasound ahead of time.
The AMA guidelines also had a note here that was in the Supercoder that we used for measurement
of hemodialysis access flow, using an indicator dilation methods, etc., etc., 90940.
So thatís different.
Now so 93990 is saying: "letís do the ultrasound".
Letís make sure weíve got good flow, good movement.
And then 90940 is: " letís measure the flow", which is an additional procedure thatís being
done.
Want to see it being done?
http://www.youtube.com/watch?v=YytiftqCKKk
This link right here isÖ was pretty good.
[Ed.
Note: http://www.gehealthcare.com/usen/community/reimbursement/docs/Vascular_Surgery_reimbursementv2.pdf ] This is one that was actually Ö theyíre
selling products.
But it broke it down for the physicians and listed the codes for reimbursement.
It is a little bit older.
Itís not up to date.
It wasnít in 2013 but I found it very interesting because again, like I mentioned when Laureen
was doing those, sometimes, when you just have a code to look at, they get you in the
right area to confirm that youíre using the right verbiage, thereís not something missingÖ
thatís all you need to be put in the right direction.
And I know if any of you guys have been coding for a while, you may just look and look and
look and you canít find it.
And someone says ìOh by the way, check out 90940.
I think thatísÖ itís going to be close to that.î And you have to be very careful
with [ICD 9], itís either one or the other.
CPT, one word can change it for you.
Again, like 93990 is the ....is almost the exact same thing as 90940.
But one is for measurement and the other one is just checking the flow.
So if you decide that you want to see them doing a duplex scan, this ultrasound, this
YouTube video I found actually shows what that looks like.
[Ed.
Note: http://www.youtube.com/watch?v=YytiftqCKKk ] And itís about 11 minutes long but itís
worth it.
Itís kind of interesting, but if you look right there, you can actually see what theyíre
looking at.
Thatís the artery and he talks about that.
And heís going to show you how he measures that ,and then heíll put the color in and
everything.
Itís worth it to look at.
If you see the other ones, it says, ìWhat does aÖî the lady thatís 1:07 [Ed.note:
1:07 into the video], ìWhat does a kidney dialysis access point look like?î And thatís
what heís checking just to make sure those veins and arteries are proper for that access
point.
So thereís some really interesting things on YouTube and again, like Laureen says, ìGoogle
it.î And youíll find access points can be put in for hemodialysis, in the arm, in the
leg, in the abdomen.
I donítÖ they can do it in the chest.
They donít do them in the neck but you can see them in a whole lot of different places.
And without getting into a long description of the different types of dialysis that you
can have, the access point is what theyíre talking about.
Now,our question though, specifically, he wanted to know ifÖ when the doctor comes
out and he marks where the vein is that heís going to do thatÖ I donít want to call it
a port but I think of it as a portÖ where theyíre going to plug in the dialysis, where
heís going to put that.
Then actually, what they do, thereís a video for that, too, but I didnít put the link
up.
ItísÖ they take the ultrasound machine and they use it, if youíve been pregnant and
theyíve, you know, youíve had that ultrasound done in your abdomen to check the baby and
itís kind of like aÖ not an oval shape but itís an arched shape ultrasound end.
I donít know exactly what you call that.
But you can put a little marker on that and it will actually mark the vein and then they
can squeeze it and itíll put a little poke in like your leg or your arm.
And then what they do is they go back and they just use a Sharpie and they literally
put a Sharpie dot everywhere there it pushed, like a little indention in your arm or your
leg.
Thatís the way they do that marking.
Itís not that big of aÖ I donít want to say itís not that big of a deal.
Thatís not the proper way to say that.
But I believe it is bundled in.
Now donít quote me on that and weíre going to have to do some more investigation.
But thatís what heís asking, can you even bill for that?
And I really, in my heart, think that itís included in the procedure, [the doctor] going
in and marking it.
The ultrasound has already been done.
The duplex study would have been done ahead of time to make sure thereís a good vein.
And then he goes in and he knows where itís at in the arm and then heís going to go mark
it, do a quick ultrasound and mark it, like I said, with those little indentions.
But weíll have to find out for sure.
So thatís something we can follow up again later.