Alicia: “What’s the proper coding to use for ultrasound vein mapping for AVF and AVG creations for hemodialysis? The doctor uses ultrasound on the patient’s arm while patient is in pre-op holding area and marks the vasculature on the patient’s skin with a marker. Is this even billable? Thanks in advance for your assistance.”
Okay, well I did a little research here …
Coding Ultrasound Vein Mapping for AVF AVG — VIDEO
Alicia: And so what we found here was this article on what upper extremity vein mapping is, and that’s a link, Laureen. You can click on that real quick and the article is pretty interesting. It is long but again, if you’re 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 clinician’s point of view on how to do it. But again, as a coder, you need to know what they’re doing so that you can get the best code. You might take some time to look that… this is an older article. Again, if this is 09… but it was really, really good. So…
Laureen: Yeah, not so much for coders, but it does help you get a feel for what they’re doing.
Alicia: Right. And it gives you the verbiage too. Sometimes, that’s all you need to get in the right direction. So what are the codes for vein mapping? These are HCPCS codes for anyone that’s new to coding and aren’t as familiar with them. HCPCS codes aren’t talked about as much, and actually not as much in the education aspect. Because on the CPC exam, there’s only 5 CPC… I mean, the HCPCS questions. But that doesn’t mean you don’t need to use it. But this is a classic example of what you learn once you’re certified and you’re out in the field. You’re 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 that’s used… 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 after… and this is the way I understand it so you need to verify this, double check it, do your research when you’re looking into this, because I’m not familiar, but 93990 reads “duplex scan of hemodialysis access including arterial inflow, body of access and venous outflow”. So what that’s telling me is they’re doing the duplex of the ultrasound skin and, duplex just means they’re doing it in grey and in color. And they’re doing the ultrasound skin to verify that the hemodialysis access or that access where the person’s 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, it’s going to work? This…I don’t 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 that’s different. Now so 93990 is saying: “let’s do the ultrasound”. Let’s make sure we’ve got good flow, good movement. And then 90940 is: ” let’s measure the flow”, which is an additional procedure that’s being done.
Want to see it being done?
This link right here is… was pretty good.
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