Vascular Mapping

ASDIN Coding University

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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 used2. 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

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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

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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

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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

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If Both Angiography and US Are Used

• There are two approaches that are commonly used for doing this procedure:1. Ultrasound only2. 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

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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 only2. Both Ultrasound and angiography (bimodal study)

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Ultrasound Only

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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

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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

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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)

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Bimodal Study

Ultrasound and Angiography

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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

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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

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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

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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

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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

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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)

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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.

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