Newsletter Archive - Fall 2012
In this Issue...
CERTIFICATION & ACCREDITATION
ASSOCIATE COMMITTEE UPDATE
ARTICLE OF INTEREST DISCUSSION
2013 comes to us on the heels of some of the most exciting and also challenging times in diagnostic and interventional nephrology. Let us take a few moments to celebrate the year that was, and to reflect upon what we might do to best prepare for what lies ahead.
We started 2012 with record attendance at the 8th Annual Scientific Meeting and outstanding feedback from our attendees and guest speakers. We thank you for your suggestions and comments and have given earnest thought to many of these as preparations for the 2013 meeting began. The Clinical Practice Committee has published guidelines for management of cardiac implantable electronic device leads in CKD and ESRD. The Society continues to cement its relationship with other nephrology specialty groups in the USA, such as ASN, NKF and RPA, and has made considerable inroads in forging ties with international nephrology groups. The Australia and New Zealand Society of Interventional Nephrology maintains a dual society physician membership, allowing its active members full ASDIN membership and on-line subscription to Seminars in Dialysis. ASDIN speakers participated in meetings of ANZSIN in Auckland, New Zealand and of the Russian Society of Nephrology in Vladivostok, Russia. Just last month, ASDIN and the Saudi Society of Nephrology and Transplantation organized and co-sponsored the inaugural Dialysis Access Symposium in Dubai, UAE. The conference was attended by over 200 health care providers, including nephrologists, surgeons, interventional nephrologists and nurses from different countries in the Middle East, including the Emirates, Saudi Arabia, Bahrain, Egypt, Libya and Lebanon. Our societies signed a Memorandum of Understanding that outlines and structures collaborative projects that are mutually aligned to both societies’ missions and will, no doubt, increase the interest in and establish the discipline of Interventional Nephrology in the Middle East. There are opportunities for educational exchange and research and we are most excited about interacting with and learning from our colleagues in that region. In May 2013, we anticipate launching our inaugural interventional nephrology workshop as a pre-course of the European Renal Association-European Dialysis and Transplantation Association Annual Meeting in Istanbul, Turkey.
As we navigate the sometimes perilous and uncertain waters of health care financing, ASDIN has been most fortunate to partner with and share in the expertise of the Renal Physicians Association. We participated in two code re-valuation surveys of the RUC/AMA in 2012 and our position was able articulated by representatives of ASDIN and RPA. We thank them for their partnership and value the on-going work as more challenges in this arena arise.
ASDIN remains your voice, and that of your patients’, in advocating for and promoting our mission of appropriate application of procedures in the care of kidney patients. We thank you for your support and engagement, and look forward to another productive and illuminating new year.
Aris Q. Urbanes, MD
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9th Annual ASDIN Scientific Meeting
Join us in Washington, DC for the 9th Annual ASDIN Scientific Meeting on Feb. 15-17, 2013 at the JW Marriott Hotel.
Washington, DC - The SEAT OF POWER, home to free attractions, family-friendly events, arts & culture, history & heritage AND ASDIN's 9th Annual Scientific Meeting. Join us in the heart of the Nation's Capital City for our 9th Annual Scientific Meeting - February 15 - 17, 2013.
Have you registered yet?
Wednesday, January 23rd is the Hotel Reservation & Scientific Meeting Registration Deadline! Punitive late fees apply after that date.
Full Program – Click here to download full program.
Registration – Regular meeting rates are valid through January 23rd
Click here to register online. You may also download and print a registration form by clicking here. After January 23, a $75 late fee per registrant will apply.
Additional Meeting Information
Please visit our website for a full program and additional meeting information. Additional information on CME and Continuing Education credit will be posted as it becomes available.
ASDIN Scientific Meeting Quick Links
ASDIN Scientific Meeting Website
Online Hotel Reservations
Administrator Pre-Course Info
Advanced Techniques Pre-Course (space is limited)
Full Program Brochure
Public Policy Update
by Timothy A. Pflederer, MD
The Public Policy Committee has been busy working for ASDIN members on a host of issues in 2012. We attended the AMA-RUC meeting early in the year to assist the Renal Physicians Association (RPA) in developing new valuation for the angioplasty codes (35475 and 35476). Working with radiological and surgical societies, the RPA was able to negotiate RVU’s for these codes that maintained most of the prior value.
Unfortunately, CMS eventually went against the AMA-RUC recommendation and levied reduction of 27% for 35475 and 14% for 35476 to the final RVU’s in the Physician Fee Schedule. These codes experienced even greater reduction in value in the Ambulatory Surgery Center Payment Schedule final rule. We have been working with the RPA, SIR, ACR, SVS, AMA, and representatives from industry to ask CMS to reverse these drastic cuts for 2013. Our comment letter was sent to CMS the last week of December but given the current political climate it is highly unlikely that the reductions in RVU will be reversed. Links to the ASDIN and RPA responses to CMS are included for your reference:
The thrombectomy code (36870) began the process of re-valuation and an ASDIN Public policy representative will be attending the AMA-RUC meeting to represent ASDIN interests in January 2013. While the RPA is nephrology’s official voice on the AMA CPT and RUC committees, they depend on ASDIN for expertise and direction related to procedural codes. A survey related to the thrombectomy code (36870) re-valuation was sent to all ASDIN members who maintain active RPA membership.
The Coding subcommittee has also been busy in 2012 answering coding questions that are submitted through our web site, monitoring changes in coding guidelines, and preparing the 2013 revision of the ASDIN coding manual. We look forward to continuing to serve ASDIN members and will keep you informed of changes as they occur in the coming year.
Finally, we want to thank Don Schon who has served as public policy committee chair for many years and has now retired to pursue other interests. We wish him the very best.
Coding Q&A is a recurring newsletter section where the ASDIN Coding WorkGroup answers a coding question or case study.
ASDIN provides our Coding Manual for members online as a membership benefit.
ASDIN accepts Coding questions through our website. To submit a question, click here.
(Member login is required)
Q: How should the following case be coded?
Case history – the patient was referred to the access center because of progressively falling access flow as determined by monthly flow measurements. The patient had a loop graft in the right thigh. Examination revealed that the pulse augmentation was poor. There was concern that the inflow was the problem.
The graft is cannulated in a retrograde direction. An angiogram showed that the arterial anastomosis with the femoral artery was greater than 50% stenotic. An angioplasty was performed with good results.
Because this is an arterial, angioplasty in the lower extremity, the lower extremity revascularization coding guidelines apply. The appropriate code for this procedure is 37224. The descriptor for this code is - revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with transluminal angioplasty. The codes of the Lower Extremity Revascularization coding system are all inclusive. Specifically, the basic cannulation is bundled with the basic procedure code. Therefore in this situation, the code 36147 should not be used (unless a second cannulation is performed). The code 75791 for the angiogram should be used alone. If it is necessary to do a second cannulation then this should be coded 36147 (since this would be the first cannulation requiring an independent code) with a -59 modifier to indicate that this is a separate procedure. When this second cannulation code is used, then 75791 would need to be dropped since it is bundled with 36147.
If both an angioplasty and a stent are placed, a single code would be used for both. This code would be 37226. Its descriptor is revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed. Supervision and interpretation codes should not be used with these codes.
Certification & Accreditation Update
by Jeffrey Hoggard, MD
The year 2012 was another busy year for the Certification and Accreditation Committee and its subcommittees. There were 27 Hemodialysis Vascular Access (HVA) certifications, 23 HVA re-certifications, 2 Ultrasound (US) certifications, and 3 Peritoneal Dialysis (PD) certifications.
Two new interventional centers were accredited as training centers.
The committee for Recertification worked to improve the member experience for certification process.
1. Revisions of the HVA certification and recertification applications including: Changes in the required number of HD catheter placements /exchanges, addition/revision of CQI requirement, definition of the timing/ duration of certification /re-certification.
2. Modification and improvements to the accreditation “on-site” evaluation process and minor but important revisions in the accreditation requirements for HVA training centers.
These changes reflect the evolution and maturation of our young society. I have great confidence in the physician members of this committee and its subcommittees.
ASDIN Associate Committee Update
by Jill Humes, Associate Committee Chair
The Associate Committee welcomed new and returning members in 2012. Workgroups were formed for planning the Associate and Administrator sessions for the 2013 Scientific Meeting.
Associate Member at 2013 Annual Meeting
A survey was sent to all ASDIN Associate members to learn more about what our Associate Members would like presented at the 2013 Scientific Meeting and to find out more about our Associate Members and how ASDIN can work to meet their interests and needs.
For the 2013 Scientific Meeting, we are pleased to offer the first full day Administrator Session to be held on Friday February 15th. We thank both workgroups for all the planning and work they have put in to provide a superb agenda for the meeting. We thank James M. Moore and Syd Stevens for their excellent leadership of these work groups.
ASDIN Associate Member credentialing program
A workgroup was formed to develop an ASDIN Associate Member credentialing program. James Bevis has done an excellent job leading this group and has made great progress in developing the initial structure for the credentialing program. We look forward to having this complete and available to offer to the Associates.
The Associate Web page continues to grow. The workgroup for the site is being revived to work on improving the site, increasing content including continuing education programs and adding a discussion board.
Congratulations to Kevin Graham for his appointment to the ASDIN Communications Committee.
by Prabir Roy-Chaudhury, MD, PhD
The Research Committee of the ASDIN grouped itself into a number of subcommittees focused on various tasks. These included:
• Basic Science and Translational Sub Committee
• Clinical Research Sub Committee
• Web Site and Communications Sub Committee
An important goal was the identification of regional resource centers for both basic science and clinical research. The Research Committee is also working with the Executive Committee of ASDIN to develop a pathway for both research grants and Young Investigator Awards (the latter for the annual meeting).
Did you know that every month co-editors Anatole Besarab, MD and Abigail Falk, MD provide ASDIN members with a guide to the most interesting literature in the IN field?
Visit Articles of Interest
A complete archive of the each month’s article listings is available online
Article of Interest Discussion
Thrombectomy procedures on AVFs are associated with lower success rate compared to AVGs. In addition to requiring significantly more time and supplies, AVF thrombectomy require significantly greater skill and entail a greater degree of difficulty than procedures on AVGs.
Thrombectomy reimbursement CPT has recently been reviewed by CMS for adjustment but no differentiation is made between AVG or AVF declot.
The study below reveals that the time required and the supplies expended to salvage a thrombosed AVF is significantly greater than that required for an AVG
Comparison of Procedure Cost for Thrombectomy of Arteriovenous Fistulas and Grafts
Expenditures on dialysis vascular access now exceed $2.5 Billion annually in the US. Studies suggest that significant savings could be achieved by increasing arteriovenous fistula (AVF) prevalence to >65%. It is common but unsubstantiated opinion that AVF have lower maintenance costs than arteriovenous grafts (AVG). This manuscript tests this hypothesis by direct comparison. Equipment utilization time and supply utilization on 110 thrombectomy procedures on AVF and 258 on AVG were compared. Procedures techniques were standardized within one facility and procedures performed by a multiple but limited number of operators. There were no significant differences in demographic variables and comorbid factors between groups. Time to complete AVF thrombectomy was 1.7 times that for AVG. In addition, major supplies used such as wires and balloons were also significantly greater. Interventionists who took longer than average to thrombectomize AVF took longer than average to thrombectomize AVG. The prevalence of arterial inflow lesions was 1.5 greater in thrombosed AVF versus Thrombosed AVG. Procedure costs when analyzed in terms of procedure time, room utilization, staff, and equipment are significantly greater for thrombosed AVF than thrombosed AVG.
1. What is your center experience with resources required for AVG vs AVF declot?
Comparison of Procedure Cost for Thrombectomy of Arteriovenous Fistulas and Grafts
Donald Schon,*† Tammy DeLozier,† and Nina Patel‡
*Arizona Kidney Disease and Hypertension Center, Phoenix, Arizona, yPrivate Practice, Montebello,
California, and zThe University of Arizona Health Science Center, Tucson, Arizona
Seminars in Dialysis—2012
Go to our online Disqus discussion board to respond to the questions above.
Consider applying for certification or accreditation through ASDIN.
For more information
see links below:
Application for Certification: Hemodialysis Vascular Access Procedures
Application for Certification: Renal Ultrasound
Application for Certification: Peritoneal Dialysis Catheters
For more information on Accreditation, click here.
Certification and Accreditation Listings
Congratulations to these physicians and programs on their certification, recertification, and accreditation. Your efforts were well worth it and applauded.
Hemodialysis Vascular Access
David Joseph DeSoto, MD
Rajiv Kumar Dhamija, MD
Alan Sedgwick Hanson, MD
Jyotheen S. Karam, MD
Stacy Zwick Ker, DO
Robert Paul Landry, MD
Benjamin S Lee, MD
Fredrick B. Lee, MD
Mark P Leischner, MD
Hasit P Pandya, MD
Dennis L. Ross, MD
Rajeev Narayan Shenoy, MD
HVA - Tunneled Catheter Procedures Only
Sancar Eke, MD
Hemodialysis Vascular Access
Arif Asif, MD
Ryan D. Evans, MD
J. Pedro Frommer, MD, FACP, FRCP(C)
Naveed UL Haq, MD
Fredrick B. Lee, MD
Ji-Yang Sophie Lee, MD
Stanley Lee, MD
James Lin, MD
Ivan D. Maya, MD
Robert A. Moffitt, MD
Nilda Roxana Neyra, MD
William Pettus, MD
James M Rajan, MD
Sandeep B. Sharma, MD
Ashish Soni, MD
Lijuan Tong, MD
Shouwen Wang, MD
Alexander Yevzlin, MD
Hemodialysis Vascular Access Training Center
The Dialysis Access Institute at The Regional Medical Center, Orangeburg, South Carolina
Dr. John Ross, MD, Training Program Director