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Newsletter Archive - Spring 2013
Winter 2013
Fall 2012

In this Issue... 


ASDIN Sponsors Programming with ERA-EDTA

The American Society of Diagnostic and Interventional Nephrology (ASDIN) was honored and delighted to sponsor jointly with the ERA-EDTA the first “Interventional Nephrology” session and workshop for the ERA-EDTA 50th Congress in Istanbul, Turkey. The morning session on May 19th and the repeat offering on the afternoon of May 20th  were aimed at the clinical nephrologist who has not performed endovascular procedures and is interested in being exposed to basic theories and a general feeling of what is involved in these procedures. Each of the three-hour sessions began with an hour of didactics that stressed the clinical indications and contraindications to these procedures, the technique, complications, their prevention and management. The didactic were followed by a hands-on workshop demonstrating both the "fluoroscopic and peritoneoscopic methods of peritoneal dialysis catheter implantation, real-time ultrasonographic cannulation of the internal jugular vein with placement of a tunneled hemodialysis catheter and simulation of a vascular access angioplasty and thrombectomy. Despite an overflow crowd for both sessions, each participant enjoyed a hands-on experience with the models and interactive time with the faculty, all of whom are active and seasoned interventionalists and thought leaders in interventional nephrology.

Many thanks to our ERA-EDTA workshop faculty who were excellent ambassadors for ASDIN in Turkey - Stephen Ash, Arif Asif, Kenneth Abreo, Gerald Beathard, Aris Urbanes, and Haimanot Wasse.

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Coding Update


Do you have Coding questions; click here to pose your question.

Coding Decoded:  Removal of Thrombus Not Associated with Thrombosed Access
By Gerald Beathard, MD, PhD

Case History:
MM is a 56 year old male with a loop graft in his left arm. The graft is 4 years old and has thrombosed 5 times. When the patient arrived at dialysis on Friday, he was not able to dialyze because his access was thrombosed. He was sent to the hospital for management. At the hospital his potassium was found to be 7.4. A temporary catheter was placed in the left internal jugular vein. The patient was dialyzed and sent home with the catheter in place.

The patient arrives 2 days later at the access center for management. On examination it was found that his access graft in the left arm did not have any flow. There was no evidence of infection. After obtaining informed consent, the patient was taken to the procedure room for a thrombectomy and removal of the temporary catheter.

The temporary catheter was removed without difficulty. During the course of the angiographic evaluation of the central veins, it was discovered that the patient had a thrombus in the left brachiocephalic vein. This thrombus was removed using an 8 French aspiration sheath. The thrombectomy procedure which required an angioplasty at the venous anastomosis was successful. After the patient had recovered from sedation he was discharged to the dialysis clinic.

In addition to the thrombectomy procedure that was performed on this patient’s dialysis access. A thrombus was removed from a vein some distance from the access. This thrombus was separate from the thrombosed access and was not directly related. Its removal warrants a separate code. The appropriate code for use here is 37187. The descriptor for this code is percutaneous transluminal mechanical thrombectomy, vein(s), including intra-procedural pharmacological thrombolytic injections and fluoroscopic guidance.

The code 37187 is a column 1 code to 36870 (thrombectomy) and is mutually exclusive; however, it does allow use with a modifier. In the scenario described above, this code should have a 59 modifier attached to indicate that it is a separate procedure.

Basically, this code can be used in 2 types of situations. The first is as described here. In this instance, it is critically important that the procedure documentation clearly indicates that the thrombus being treated was totally separate from the thrombosis within the access. It cannot be an embolus from nor can it be an extension of the thrombus within the access.

The second situation in which this code could be used is when a thrombus is present but the access is not thrombosed, flow is present. In this instance, the use of the thrombectomy code would not be appropriate since the access is still functional. This is an in situ thrombus. The same situation would hold for any vessel.

Occasionally, this situation also occurs within an artery. In this instance the code 37184 should be used.


Article of Interest Discussion


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


Objective and subjective assessment of physician labor and resource utilization in maintenance percutaneous transluminal angioplasty of nonthrombosed hemodialysis arteriovenous fistulas versus arteriovenous grafts
Journal Vasc Interv Radiology. 2013 May; 24(5):722-5

Key Message from the study:

  1. No significant difference in resource utilization between maintenance PTA of nonthromobosed AVFs versus AVGs
  2. Maintenance PTA of AVFs was scored as more cognitively, physically, and psychologically demanding than maintenance PTA of AVGs

Questions for the readers:

Practices can vary widely, a large series of over 150 PTAs of AVF and 3500 PTAs of AVG [KI (2400) 66, 1622-1632] showed a difference of time to complete angioplasty of 38.8 ± 23.9 versus 24.4 ± 15.5 minutes. Mean fluoroscopy time was also higher for AVF PTA’s (mean fluoroscopy time was 6 ± 4.8 versus 4 ± 3 minutes). What differences are seen in your practice if any?

Follow discussion/leave comments HERE.


2014 Physician Fee Schedule

CMS released the 2014 Physician Fee Schedule proposed rule this week which contains significant and unexpected reductions in relative values for many endovascular procedure codes. The codes related to dialysis vascular access have all been reduced in value by an approximate average of 10%. This includes commonly used codes: 35475 (arterial angioplasty), 35476 (venous angioplasty), 36870 (thrombectomy) – among others. Indeed, 36147 (angiogram of dialysis access) was reduced by over 30%. It appears that CMS made these drastic cuts in the practice expense  or facility calculation and not the physician work component. We are very concerned that these changes could have dramatic impact on the ability of dedicated dialysis vascular access centers to provide patient care since these centers have already been challenged by significant recent cuts in angioplasty and other codes. We are evaluating this just released CMS proposed rule and anticipate responding to CMS during the comment period to argue against these drastic payment reductions that are likely to hinder our patient’s access to high quality care. We are also looking at ways in which we can work with other stakeholders and societies, which have expressed similar alarm and distress.  We will keep you informed as more information becomes available and encourage you to plan to contact CMS as well.

The proposed physician fee schedule can be found at:

The proposed ASC fee schedule can be found at:

Payment Adjustments and Hardship Exceptions for the Medicare EHR Incentive Program

By Timothy A. Pflederer, MD
Chair, ASDIN Public Policy Committee

Many of you have found the Meaningful use requirements to be difficult to attain in your practice setting. The criteria for meeting stage 2 meaningful use have increased and shortly there will be penalties on all Medicare payments to those who do not attest successfully. The following Medicare Learning Network (MLN) webinar may be of interest if you are considering applying for a hardship exception to opt out of the program and penalties.

Registration now open - Thursday, August 15; 1:30-3:00 EDT
To Register: Visit MLN Connects Upcoming Calls. Registration will open soon.
Target Audience: Eligible hospitals and eligible professionals,
Beginning in 2015, Medicare eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) that do not successfully demonstrate meaningful use will be subject to a payment adjustment. The payment adjustments for EPs start at 1% and increase each year up to 5% if the provider does not demonstrate meaningful use of Electronic Health Record (EHR) technology. Join the CMS experts on an MLN Connects Call to learn who will be affected, how to apply for an exception if you are eligible, and how the payment adjustment will be applied. Note: Providers which are not eligible for the Medicare EHR incentive program, or who successfully attest to the Medicaid EHR incentive program, will not be subject to payment adjustments.

• Who is subject to payment adjustments
• Who can request an exception
• Adjustments for professionals
• Adjustments for hospitals and CAHs

Continuing education credit may be awarded for participation in certain MLN Connects Calls. Visit the Continuing Education Credit Information web page to learn more.



ASDIN 10th Annual Scientific Meeting

2/21 - 2/23/2014

















ISHD Nephrology Congress
September 11th-14th



Meeting Update

The American Society of Diagnostic & Interventional Nephrology (ASDIN) is proud to announce that the 10th Annual ASDIN Scientific Meeting will be held during February 21–23, 2014 at the JW Marriott Desert Ridge, Phoenix, Arizona.  


The ASDIN Scientific Meeting offers a variety of educational and networking opportunities. In addition to the general sessions which will feature outstanding speakers sharing cutting-edge knowledge on a variety of topics in the field of diagnostic and interventional nephrology, there will be programming for nurses, techs, an administrator session, abstract presentations, and product exhibits, which will showcase the latest in interventional nephrology products. The 10th Annual Scientific Meeting will build on the success and content offered this year in Washington, DC. Mark your calendars and plan to attend.

Program details will be announced on the ASDIN website ( and through conference mailings and emails.

The Annual Meeting host hotel is the JW Marriott Desert Ridge Resort & Spa. A fantastic peak season group rate of $240 single/double offered to ASDIN’s attendees. Reserve online at: ASDIN rate is available through January 29, 2014 or until all rooms are sold.

Located in northeast Phoenix near the Scottsdale boundary, this 316-acre desert oasis features views of the McDowell Mountains and offers holidays for golfers (2 Golf Courses!).  A four-acre water complex including swimming pools, pool umbrellas, spa tubs, water slide, and lazy river entertains families, while a 28,000-square-foot health-and-beauty spa rejuvenates adults/couples.


ASDIN will be co-sponsoring a session at the upcoming ISHD Congress in Buenos Aires, Argentina.  For more information on the meeting, go to:


Associates Update

ASDIN Associate Member Update
By Jill Humes, BSN, RN

ASDIN membership has its privileges!  We continue to want to serve you and your needs as the leader in our industry and the value of ASDIN and the Associate Member website is only getting better.

Presently you have access to great clinical, administrative, and operational resources but more remains with how we can network, learn, advance and lead together.  The Associates Committee has been brainstorming and planning for added resources in the coming months on important topics that include:

  • Management of patient flow:  scheduling, planning, no-shows, and follow up
  • Infection Control & Patient Safety:  building blocks for quality care
  • Managing Teammates:  hiring the right person for the right job, mentoring to success
  • Survey Readiness: staff knowledge, checklists, and surveillance
  • Quality Assurance/ Continuous Quality Improvement – how to create a program, resources, and implementation
  • Patient education resources on vascular access and vascular access procedures
  • Conflict Resolution:  dealing with difficult patients/staff, patient satisfaction
  • Resources for Managing and Measuring staff competency (moderate sedation for nursing, laboratory meters, etc.)
  • Customer Service:  developing a good rapport and communication with the dialysis units
  • Case Cost Management – setting a benchmark within your center

As new content becomes available on specific topics, we will highlight these in future newsletters, add to the website, and send you email alert notification.  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! Please, send an email to or call 601-924-2220.

ASDIN Officer/Councilor Elections

2014 ASDIN Election Cycle

The Nominating Committee of the American Society of Diagnostic & Interventional Nephrology (ASDIN) will soon be soliciting nominations for candidates for ASDIN Officers (President-Elect, Secretary/Treasurer)  and the ASDIN Council (3 positions for a three-year term) for the 2014 election cycle. As a growing and dynamic professional organization, we invite Active physician members committed to the mission and purposes of ASDIN to participate in leading ASDIN forward. 

Be on the look out for the Call for Nominations that will be distributed by email soon.

ASDIN Nominating Committee:
Timothy A. Pflederer, MD, Chair
Anil K. Agarwal, MD
George Nasser, MD 

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 on their certification, recertification, and accreditation.  Your efforts were well worth it and are applauded.


Hemodialysis Vascular Access
Dion L. Franga, MD
Dany Issa, MD
James Rajan, MD
Karthik Ramani, MD
Pierre Joseph Souraty, MD 
Wissam Saliba, MD

Amy C. Dwyer, MD
Elvira O. Gosmanova, MD


Hemodialysis Vascular Access

Naveen Atray, MD
Abdul-Jabbar Khan, MD
David Michael Lefler, Jr. DO
Peter S Leopold, MD
Graham Edward John Rodwell, MD
Kyle Smith, MD
Aris Q Urbanes, MD
Stephen Paul Wilber, MD

Contact ASDIN at or 601-924-2220 


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