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Welcome to the Inaugural Issue of the ASDIN Newsletter!

This newsletter has been created to share information with the members of ASDIN on a quarterly basis.  We encourage members to share this publication with others who might have an interest in the items included in the newsletter. We will distribute the newsletter by email to our members and post online and on social media, at the beginning of each quarter.
In each newsletter issue, you will find the most up-to-date information on all ASDIN activities.  There will be recurring sections including a Coding Q&A developed by the ASDIN Coding WorkGroup and a featured Article with a link to an online discussion board.
On the left hand side, the menu will allow you to link straight to that article for quick reference or scroll down to read the entire newsletter.  
We welcome your feedback and suggestions to improve this newsletter and other means by which we communicate and interact.   Contact us at

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ASDIN 9th Annual Scientific Meeting - #ASDIN2013


















NEW this year -
Video session!!!

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.
Program Co-DirectorsTushar Vachharajani, MD and Haimanot Wasse, MD and the Program Committee, Abigail Falk, MD, George Nassar, MD, Bharat Sachdeva, MD, and Yael Vin, MD are putting together a great program with a fresh look and special emphasis on diversity of national and international speakers representing nephrology, radiology and surgery.
Drs. Dirk Hentschel and Peter Wayne are chairing the Advanced Techniques Pre-Course on Friday, February 15th prior to the Scientific Meeting. This full-day hands-on session for physicians is always a popular education program with limited and separate registration.
The revised main meeting format includes topics that will keep a novice as well as an experienced practitioner engaged throughout the meeting. Some of the new sessions include: Point/Counterpoint sessions, Nuts and Bolts of Endovascular Intervention, Panel Discussion on Morbidity and Mortality, Journal Club: Hot Topics in the Literature, and Advances in AV Access.
The program will be limited to one breakout session for physicians on Non-Dialysis Procedures & Techniques. The abstract presentation will be part of the main meeting providing enough encouragement to presenters and opportunity for stimulating and interesting discussions. Call for Abstracts may be found online here. Scholarships are also available for fellows. Click here for more info on Scholarships.
A new feature this year is the video session in the exhibit hall displaying interesting case presentations. The video sub-committee headed by Yael Vin, MD and assisted by Ted Saad, MD and Antoine Samaha, MD has been entrusted with the responsibility of selecting and finalizing the videos.
There will also be sessions for Administrators and Associate Members covering topic for their areas of expertise.

Online registration will open November 1, 2012. 



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 memberhsip benefit.
ASDIN accepts Coding questions through our website. To submit a question,
click here. 
(Member login is required)

Q:  How should the second angioplasty performed on the following patient be coded?
The patient presents with a thrombosed AVG that is cannulated just above the arterial anastomosis and a 7 French sheath was inserted. A 5 French catheter was inserted over a guidewire and passed up to the central veins. An angiogram was done which showed no evidence of stenosis. The patient was sedated and heparin was administered.
A second cannulation was performed, a sheath was inserted and the thrombectomy was performed. An angioplasty was performed at the venous anastomosis with a 7 X 40 balloon reducing the stenosis from 80% to 10% with good antegrade flow. The sheaths were removed and the patient was transferred to the recovery area.
In the recovery area the AVG was found to have no flow and the patient was returned to the procedure room. Diagnostic angiogram showed axillary vein thrombus. The AVG was patent, but there was now a 50% stenosis at the venous anastomosis. The clot was removed by aspiration; repeat angioplasty was then performed with an 8 X 4 angioplasty balloon with a 3’ inflation time, resulting in complete dilatation of the lesion with no residual. Following this, flow was brisk.
The patient was observed for one hour in the recovery area. Flow continued to be good and was measured at 1,028 mL/min.

The second angioplasty should not be coded. The code 36870 (Thrombectomy) has a 90 day global period. In this case, the procedure did not meet the definition of a successful thrombectomy and had to be immediately repeated. This would indicate that the first procedure was incomplete. In other words, the second procedure was for the same problem as was the first. Therefore, there is no basis for coding it as a separate distinct procedure.
It is not infrequent for a second thrombectomy to occur during the global period. However, in most instances it represents a totally new problem, not related to the previous event. For example, if a patient has a successful thrombectomy and then 2 months later, has a hypotensive episode that leads to a thrombosis. It can be considered as a separate and distinct event, not related to the previous occurrence. In this instance the thrombectomy can be coded and billed even though it is within the global period. A 79 modifier should be attached to indicate that this is a procedure performed during the global period that is unrelated to the original procedure.


Click here for SID Submission Instructions

Seminars in Dialysis

Because we have had so many good articles submitted in interventional and diagnostic science and practice, we have exceeded our allotted pages in Seminars in Dialysis (SID). In order to continue to publish these excellent articles we have expanded our electronic pages. To maintain or improve our high impact factor, we will publish case reports, "how I do it"
cases, and technical notes in electronic pages. As a result of this policy we have expanded the pages for publication of our society's articles by 50%.  Authors will be informed at the time of acceptance of the paper whether it will be published in print and electronic pages, or in electronic pages only. 

The Editors of the ASDIN section of Seminars in Dialysis would like to announce a new category of submission to our readership. Beginning in the next issue of SID we will consider for publication original manuscripts that fit under the heading of "Innovative Intervention." The Innovative Intervention Forum is intended to focus on original investigations of new devices, novel procedures, or therapies that address diseases or problems for which we have not had adequate solutions before. We envision that we would publish at most one such article in each issue of SID.


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

The article below engendered a lively debate among the Articles of Interest editors and articles selection committee. We invite your comments and feedback. The discussion questions are:
1.      Should Staph aureus be treated like any other organism that leads to catheter related blood stream infection?

2.      Will the findings in the article affect your practice?

Staphylococcus-Infected Tunneled Dialysis Catheters: Is Over-the-Wire Exchange an Appropriate Management Option?
Jessica M. Langer • Raphael M. Cohen • Jeffrey S. Berns • Jesse Chittams • Emily T. Cooper • Scott O. Trerotola
Cardiovasc Intervent Radiol (2011) 34:1230–1235
DOI 10.1007/s00270-011-0180-4
Go to our online Disqus discussion board to respond to the questions above.



12/27 & 12/28/2012

Dubai Conference - December 27th & 28th

On December 27-28, 2012, ASDIN will hold it’s inaugural Middle Eastern regional conference on Dialysis Access in Dubai, with additional workshops on subsequent days for physicians, RNs, and RTs in Riyadh, Jeddah and Dammam. This meeting is co-sponsored by the Saudi Society of Nephrology. The ASDIN faculty is stellar and include Drs. Naveed Haq (Program Director), Gerald Beathard, Steve Ash, Arif Asif, Anil Agarwal, Aris Urbanes, and Tushar Vachharajani.The symposium will feature hands on workshops, live case transmission, and will be CME accredited. 

If you are a nephrologist, vascular surgeon, interventional radiologist, dialysis nurse, or technician, the Dialysis Access Symposium in Dubai is for you.  

For more information, you may contact the Saudi Society of Nephrology at P.O. Box 241437, Riyadh-11322, Kingdom of Saudi Arabia. Telephone: (+966-1)225-5547, Fax: (+966-1)225-5543 Website:  Email:



For more information on the Data Registry -
Click here!

ASDIN Data Registry

The ASDIN Dialysis Access Procedure Outcomes Benchmarking Registry has been undergoing major renovations to fix problems with its functionality over the past several months. Unfortunately, this has delayed the availability of specific benchmarking data for participants. At the end of 2011, all participants received aggregate data from the registry for their use but were unable to obtain their own specific data for comparison.
We are pleased to announce that the Registry problems have been corrected and you are now able to submit data as previously. Full reporting function will be available for users beginning in the near future. To learn more or to access the registry, please visit the Registry Webpage.

We encourage everyone to do the following:
1. Register to participate
(If you were a registered user before the system upgrade, click here for special instructions.)
2. Begin submitting data
3. Submit your suggestions for changes to the database or data collected to make this tool most useful for your situation.  You may email or use the Contact Us tab within the registry system.
The ASDIN Quality and Outcomes Committee will very soon begin a process of changing the data collected to ensure that this tool brings maximum benefit.


For a complete listing of ASDIN Committees,
click here.

ASDIN Committees at Work

Clinical Practice Committee
The ASDIN Clinical Practice Committee recently released a practice guideline paper entitled - Cardiovascular Implantable Electronic Device Leads in CKD and ESRD Patients: Review and Recommendations for Practice.  Click the title to access the paper online.

HVA Curriculum Sub-Committee (Education Committee)
The curriculum subcommittee and Dr. Gerald Beathard are working on a revised and updated edition of the hemodialysis vascular access curriculum. It is currently under review and will be made available soon. The subcommittee is also working on making the peritoneal dialysis curriculum available in an electronic version to the readers, currently available in a book format only. We are also very excited about an upcoming series of web-based CME educational updates/lectures and the creation of the Interventional Nephrology Self-Assessment Program (IN-SAP). When IN-SAP is introduced it will be available to ASDIN members 3-4 times a year through the ASDIN website.  

International Sub-Committee (Education Committee)
ASDIN has begun a Global Initiative to spread the mission of improving the dialysis access care worldwide. As part of this global initiative ASDIN is actively pursuing collaboration with renal societies from several countries. The Australia New Zealand Society of Interventional Nephrology (ANZSIN) is our first affiliate society and ASDIN welcomes our new members.


Renal Physician Association
Membership information is available at or by contacting the RPA office at 301-468-3515.


by Chet Amedia, MD

A checklist of essentials for today's professional may read something like this:
• iPhone
• Laptop
• Bottled water
• Flashlight
• Pen and paper
• Toothbrush
• Reading glasses
• RPA membership
The last item may have caught you by surprise.

I understand that right now you are probably looking at your bottom-line to see where you can cut costs; association membership dues may be one of the things on the chopping block. But before you swing the ax, I would like to share something with you. The Renal Physicians Association (RPA) has worked on behalf of the entire specialty of nephrology for nearly 40 years, and it is only because of the support of our members that it has been able to achieve extraordinary success.

One of the areas in which RPA has had victories is in obtaining appropriate valuation for physician services which ultimately translate to physician reimbursement. RPA is the only nephrology organization in the AMA House of Delegates, and as a result, the only nephrology organization with seats at the CPT Editorial Panel, where procedure codes are created and modified, and the Relative Value Update Committee (RUC) where those codes are valued. 

The RPA has been working closely with ASDIN to accurately represent interventional nephrologists on both committees.  Of recent specific interest to interventional nephrologists, two codes are to be reviewed by the RUC over the next several weeks that will have a major impact on reimbursement for physician work.  

To facilitate appropriate review of these codes, RPA surveyed RPA-ASDIN physician members who provide these services, collated and analyzed the results, and then coordinated with other specialty organizations to submit proposals to the RUC in a timely manner.

It is likely that other codes for services commonly provided by interventional nephrologists will be reviewed by the RUC over the next year.  Our ability to effectively perform in these potentially contentious situations can be improved by increasing the number of interventional nephrologists who are members in both organizations, thus expanding our ranks and enhancing our influence.

In addition to helping nephrologists realize their appropriate valuation, RPA provides nephrology practices with a unique business benchmarking survey. This is the only nephrology data source that offers you the opportunity to compare your practice to others nationwide. This publication is based on real-world nephrology practice data and includes information on charges, payments, accounts receivables, medical director services, compensation details, utilization of various codes, financial information, and much more for traditional and interventional practitioners.  RPA members receive this publication (as well as all other RPA products) at a significantly discounted rate.

This is a critical time in the health care evolutionary process, and it is imperative that you have an advocate that represents your interests at not only CPT and RUC, but also with CMS and on Capitol Hill.   RPA provides added-value to your association with ASDIN enhancing the collective voice of both organizations among regulators and legislators. I encourage you to join RPA today so that you can begin receiving targeted resources to assist you to run your practice efficiently and effectively. 


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
Suman Bireddy, MD
Shahid Hussain, MD
Ali Raza Khan, MD
Ajith J. Kumar, MD
JulieAnne Gibson McGregor, MD
Nathan Anthony Saucier, MD
Jose B Sibal, MD
Joshua Charles Sysak, MD
Abraham Thomas, MD, MPH, FACP

Rajeev Narayan, MD
Randall Lee Rasmussen, MD
Adrian Pradeep Sequeira, MD

Maureen Achuko, MD
Renee Ann Ellis, MD

Hemodialysis Vascular Access
Anthony J. Degenhard, DO
Awad A. El-Magbri, MD
Yuan Lu, MD
John D. Reed, MD
Jamie Lynn Ross, MD


Hemodialysis Vascular Access Training Center
Dialysis Access Group of Wake Forest University, Winston Salem, NC
Dr. Shahriar Moossavi, Training Program Director

Contact ASDIN at or 601-924-2220 


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