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Newsletter Archive - Winter 2013
Fall 2012

In this Issue... 





Scientific Meeting Recap

ASDIN just completed a highly successfully Scientific Meeting, which included an Advanced Techniques Pre-Course and our first-ever Administrator/Manager Pre-Course event.  All accounts and reports regarding the meeting have been glowing and enthusiastic. The Program Chairs, Tushar Vachharajani, MD, FASN, FACP and Haimanot Wasse, MD, MPH, FASN developed a program that addressed the needs of the membership, with a more interactive format.  They brought in a more diverse perspective and insight from various disciplines, setting a new bar for succeeding ASDIN programs.

2013 Scientific Meeting Chairs - Tushar Vachharajani and Monnie Wasse
Also pictured Anil Agarwal, Chair, ASDIN Education Committee

The Program Chairs were assisted in the program construct by the Meeting Committee:  Abigail Falk, MD, FSIR, George Nassar, MD, Bharat Sachdeva, MD, and Yael Vin, MD.

To view more meeting photos - visit these links:
General and Breakout Sessions
Exhibit Hall/Abstracts/Video Session/Other General Photos

Another new and well-received feature at this year’s Scientific Meeting was the video session displaying interesting case presentations and procedures. The video sub-committee headed by Yael Vin, MD and assisted by Ted Saad, MD and Antoine Samaha, MD put together the video session and will coordinate the posting of the video sessions online through the ASDIN website. We are working through requirements for video posting

Special thanks to Syd Stevens, CPC, CIMC, Midwest Nephrology Consultants, PA, Kansas City, Missouri and Charles Boyer, PA, University of Michigan, Interventional Nephrology, Ann Arbor, Michigan for their coordination of the successful first-ever Administrator/Manager Pre-Course held February 15, 2013.  Also, special acknowledgement to James M. Moore, RT(R)(CV), Lifeline Vascular Access, Fairmont, West Virginia, for his coordination of the Non Physician Breakout session that was held Saturday, February 16th for nurses, technicians and other non physician ASDIN Associate members. 

This program was made possible by our 2013 Corporate Partners:


Advanced Techniques Pre-Course
Advanced Techniques Pre-Course Chairs, Dirk Hentschel, MD, Brigham and Women's Hospital, Renal Division, Boston, Massachusetts and Peter H. Wayne, III, MD, Diagnostic X-Ray Physicians (DXP), Louisville, Kentucky constructed a challenging Pre-Course program which included afternoon sessions with eleven hands-on workshops, three featuring cadaver arms. Registration was capped at 80 and registration inquiries exceeded this number.  The ASDIN Advanced Techniques Pre-Course always fills early.  Members are encouraged to sign up for this program early.

Many special thanks to the following companies who supported the Pre-Course with materials, staff and simulators:

Atrium Medical Corporation
Bard Peripheral Vascular
Cook Medical
Merit Medical Systems
Teleflex Medical
W L Gore


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ASDIN recently recognized our 2013 award recipients at the 9th Annual Scientific Meeting.

Charmaine E. Lok, MD, Clinical Investigator and Associate Professor of the University of Toronto was recognized as the most recent Gerald Beathard Award recipient.  The Gerald Beathard Award is presented periodically in recognition of teaching excellence, scholarly activity, and clinical excellence.


Timothy A. Pflederer, MD, of Renal Care Associates in Morton, Illinois and Immediate Past President of ASDIN was also recognized with the ASDIN Distinguished Service Award for his extraordinary service to the society.


Coding Update

Understanding the  Global Period for Thrombectomy






















 AY Modifier for t-PA (J2997)

 Understanding The Global Period for Thrombectomy (36870)
By Gerald Beathard, MD, PhD

It is apparent that the question of the global period for a thrombectomy continues is a point of confusion since it continues to come up. It is true that there is a global period of 90 days listed for this procedure, but it is also true that a repeat thrombectomy procedure is rarely affected if ever by this fact.


Here are a several plausible scenarios that one might encounter:

Case scenario #1
The patient has a thrombectomy and then three weeks later they have a hypotensive episode and another thrombosis of their access. This should be coded as 36870-79. This would not be affected by the global period because it is a separate incident, not a continuation of the first. The first thrombectomy was successful and was complete. This is a new problem caused by an unrelated event.   

Case scenario #2
The patient has a thrombectomy and then three weeks later they have a venous angioplasty of their access. This should be coded as 35476-79, 75978. In this instance the angioplasty is not related to the thrombectomy, it is a separate procedure.
In both of these cases, the 79 modifier was used to tell the reviewer that although this procedure was performed during the global period for the initial procedure, it is actually unrelated. Note that this is a service provided by the same physician or other qualified healthcare professional. In other words it even if it is not the same physician, the modifier should be used even if another physician performs the second procedure. This is assuming that physician performing the second procedure was actually aware of the initial procedure.

Case scenario #3
A patient was admitted to the access center with a thrombosed access. The procedure was initiated. During this period an angiogram was performed, clot was removed and an angioplasty was performed. However, it was not possible to restore flow; the patient had several large pseudoaneurysms that were filled with old adherent clot that were resistant to attempts at removal. The patient was referred to the hospital where a second thrombectomy was performed by a surgeon. 

In this instance, the access center should code the case as 36870. This is warranted even though flow was not restored. It is not necessary that the procedure be successful to warrant coding, only that the work be done. The surgeon would code the procedure as an open thrombectomy.

AY Modifier for t-PA (J2997)

On January 1, 2011, ESRD Consolidated Billing regulations went into effect. According to CMS Transmittal 2134, CR 7064, certain lab tests and limited drugs and supplies are subject to part B consolidated billing and are not separately payable when provided for ESRD beneficiaries by providers other than the renal dialysis facility. These regulations only cover those services/supplies/drugs that are related to the beneficiary’s dialysis treatment.

An AY modifier (HCPCS) was created as a way for non-dialysis facilities to identify laboratory tests and drugs that are not related to the beneficiary’s dialysis treatment. The attachment of this modifier allows for separate payment outside of the ESRD PPS (prospective payment system). If the AY modifier is not attached, the claims will be returned with claim adjustment reason code (CARC) 109. This indicates that the claim is not covered by this payer/contractor). The dialysis facility is responsible for payment to outside providers who furnish covered services/supplies/drugs to its patients.

With the institution of these regulations, many dialysis facilities elected to longer perform thrombolytic treatment of dysfunctional catheters. These cases are now being referred to outside facilities for management. It is recommended that the AY modifier be attached to the code for the drug (J2997) when used in the access center to assure payment. This is warranted since the treatment of the catheter is not part of the beneficiary’s dialysis treatment.


Public Policy Update
Timothy A. Pflederer, MD

Our committee is working hard to represent the membership and our patients in these changing times in healthcare. Each year we revise the coding manual and an update for 2013 was just released. The coding subcommittee will be reporting those things separately in this issue of the newsletter. We are monitoring the CMS Center for Innovation End Stage Renal Disease Seamless Care Organization (ESCO) developments and passing information along to you as quickly as possible. The most recent development was the announcement that CMS extended the deadline for participation: Letters of intent are due by May 15, 2013 and final application is due by July 15, 2013. Most people believe that CMS will be making other changes to the program that could make it more attractive to participate so stay tuned. On March 27 we met with CMS along with the RPA and industry to ask that they reverse the dramatic reduction in value of the angioplasty codes 35475 and 35476. We met with a number of administrators and medical officers to present the case that CMS used incorrect comparator codes to determine the valuation of venous and arterial angioplasty. It was that incorrect decision that led to the most severe reduction in both work and practice expense RVU’s. We are hopeful that the message can have an impact in the 2014 Physician Fee Schedule. We are also working closely with the RPA and other societies including the AMA, ACR, SIR and SVS to give input to the revaluation and changes occurring with thrombectomy (36870) and stent (37205-6) codes. 

Finally, we are working to develop a more coordinated network of physicians who serve on local carrier medical advisory committees so that we can be made aware of issues affecting local practice and can have voice with carrier medical directors when policy affecting interventional nephrology is being developed. Please contact us if you are involved with a CAC and would be willing to work with us.






ASDIN is increasingly being recognized as a major global stakeholder in the welfare of dialysis access related issues. Through strategic alliances with prominent kidney organizations worldwide, ASDIN is poised to provide avenues of education and assistance in developing IN in the rest of the world.

The ASDIN is pleased to announce that during the upcoming ERA-EDTA Congress (May 18-21, 2013, Istanbul, Turkey), ASDIN is conducting two 3 hour hands-on and didactic workshops on the morning of May 19 and the afternoon of May 20, 2013. The workshops will provide hands-on experience in dialysis access techniques, including angioplasty/declot, tunneled catheter placement and peritoneal catheter placement (by peritoneoscopic and fluoroscopic techniques). We are excited to announce that six eminent speakers Stephen Ash, Arif Asif, Kenneth Abreo, Gerald Beathard, Aris Urbanes and Monnie Wasse from ASDIN will represent ASDIN at the Congress and will enhance the presence and exposure of ASDIN on an international stage.
We encourage our members who are attending the Congress in beautiful Istanbul to consider attending the workshops. Please also disseminate word to your colleagues who might be attending the meeting. Please see the preliminary program of the Congress at


Associates Update

David Doane recognized



 Associates Credentialing



























Associate Website


ASDIN Associate Committee Update

David Doane of Dallas Nephrology Associates and a long-time ASDIN Associate-Administrator member was recently recognized as the Renal Physicians Association Administrator of the Year.  Congratulations David on this high honor!

Associates Credentialing
by Jim Bevis, RT, R

Over the past year, Dr. Urbanes has tasked the Associate Credentialing Committee with the development of a certification program for our associate members at the ASDIN.
The committee has dedicated many hours to the development of the programs structure and content in 2012, and we now have a
working draft that the committee would like to share with our membership. The link below will take you to the outline for certification. Please review our progress and give us feedback as we prepare for the possible offering of this certification in 2013-2014 

Review Draft Document HERE

The purpose of the ASDIN Associates Credentialing program is to provide an avenue for non-physician members of the ASDIN a path to ASDIN Certification within our scholarly institution. The program seeks to further develop and foster academic achievement in our clinical practices by evaluating and defining minimal standards for certification in the field of interventional nephrology and vascular surgery. By setting certification standards, the committee seeks to increase participation of our non-physician members and elevate the stander of practice in the field.

The structure of the registration process includes a didactic procedural performance component. Each eligible procedure for certification is identified in the procedural table, and the criterion for inclusion is defined. An eligible procedure must be performed and validated by an identified preceptor at a minimum of 5 repetitions, and or a maximum of 20 repetitions per procedure. Each candidate must complete a total of 200 procedural repetitions across the listed field of exams. A 24-month window for the performance and recording of the procedures is provided for in the program. After the procedures are performed and recorded, and the necessary paperwork is submitted, the ASDIN will consider the candidate for certification.
 Many individuals have been in the field providing leadership over the years of ASDIN establishment, and may not be in a clinical setting during the initial offering of this certification. A grandfather clause is being considered for certification in order to provide for individuals that have been in the profession for an extended period. The grandfather period will be open for the first two years that the certification is offered. After the first two years of establishment, the grandfather period will close. Professionals that can validate 10 years of service and have a preceptor verify that you have performed greater than 200 repetitions of the listed procedures will be considered for inclusion.

The ASDIN associate credentialing program is a work in progress, and your feedback is much appreciated. Please send your comments to If you would like to participate in the development process of the certification as we refine this program over the coming year, please reach out to the committee at the e-mail address listed above. Thank you for your interest in the program, if you would like to take a closer look at the working draft of the certification packet, please see the link below for a preview. 

Associate Member Website
by Kevin W. Graham,

Congratulations to the contributors and attendees to this year’s annual meeting for making the Associates’ program our best attended yet.  While we wait for final program evaluations and details, we know that planning of this year’s program and topics were the direct result of your feedback and input on what was most important and impacting for you as an Associate member.   This year’s meeting was a great opportunity to reconnect with friends and colleagues, make new ones, and learn about key topics that impact our varied roles and community in this industry.  

As a community we want to highlight the value of ASDIN and the Associate Member website.

Did you know with your membership, you have access to great clinical, administrative, and operational resources?  Just some of the top resources available via your website include:
• Animated training resource for performing a proper physical exam of an AV fistula
• Basic principles involved in Radiation Safety
• Links to reference Guides to Preventing Infections by the Safe Care Campaign
• Free CEU opportunities for nurses and staff

In continued efforts to respond to our membership, we have committees of volunteers working on additional tools and resources to support you.  Look out for an upcoming resource page that will list, by state, important links to information regarding newly implemented or pending policy changes, updated regulatory guidelines,  and licensing rules that may impact patient care, operational, and clinical issues within our industry.  Additionally, one work group will begin development this month on a position statement and training module for non-dialysis caregivers on catheter management and use.  This is an important resource that builds on the expertise of our membership by offering a resource and service that impacts patient care while focusing on minimizing risks for infection.  

Please, know that this membership community needs your continued support and participation.  If you would like to contribute to content on the Associate Member website, participate on a work group, or offer suggestions on topics of interest, we want to hear from you and welcome your contribution! Online Interest Survey: or send an email to or call 601-924-2220.


Council Elections

ASDIN appreciates the member participation of those who voted in the annual ASDIN Councilor election.  The following ASDIN members were elected to the ASDIN Council for a three year term beginning at the Annual Scientific Meeting and continuing until 2016:

Amy Dwyer, MD
Jeffrey Hoggard, MD
Jamie Ross, MD
Tushar Vachharajani, MD
Haimanot Wasse, MD

Antoine Samaha, MD and Donald Schon, MD are completing their service to the ASDIN Council.  Dr. Samaha served as ASDIN Councilor for two terms from 2007 to 2013.  Dr. Schon served ASDIN from 2005 to 2013. 

Prabir Roy-Chaudhury, MD, PhD will be serving on the ASDIN Council for the remaining portion of Dr. Schon’s  term through 2014.


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

Aakash R. Amin, MD
Douglas L. Bunting, MD
William O. Hurtado-Santiago, MD
Nishant Jalandhara, MD
Chijioke Ogbu, MD
Sejal R. Patel, MD
Matthew Kernan Sanger, MD
Roman A. Shingarev, MD
Hemender S. Vats, MD


Adina Simona Voiculescu, MD


Hemodialysis Vascular Access

Emil S Abdulhayoglu, MD
Akash Ahuja, MD
Gerald Beathard, MD
George M. Behrend
Florin Gadalean, MD
Danyal Hassan, MD
Jerry W. Jackson, MD
Gary Saito, MD
Y. Foli Sekyema, MD



Hemodialysis Vascular Access Training Center
University Vascular Access Center
University of Tennessee - Memphis, TN
Training Program Director:
Ammar Almehmi, MD, MPH, FASN 


Contact ASDIN at or 601-924-2220 


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