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American Society of Diagnostic and Interventional Nephrology: ASDIN News and Update

Coding of interventional procedures has always been a difficult and, at times, confusing task. However, for a number of reasons it is important that it be done correctly and consistently. For this reason, The American Society of Diagnostic and Interventional Nephrology established a Coding Committee to develop an educational document to outline recommendations for the most appropriate coding practices for interventional procedures and have published them as Coding Manual for 2009. This activity was accomplished in conjunction with The Renal Physicians Association (http://www.renalmd.org) which has been very supportive and has made many helpful contributions to the final product. This is actually, the third iteration of this document, being first published in 2005 and revised in 2006. Since that time there have been several significant changes. The purpose of this communication is to present what is felt to be the most important of these changes and high-light some areas that are felt to be deserving of special emphasis. Many things have changed since the first edition of this manual. Some have been mandated by the CPT committee, some by CMS and some by an intensive review of practice patterns by the ASDIN coding committee. In addition, differences existed in coding recommendations for the same procedures between SIR (Society for Interventional Radiology) and ASDIN. Because this caused confusion for coders andCMS intermediaries a combined committee of the two societies was formed. The members of the committee included Sandy Altman,M.D., Zeke Silva, andKathyKrol for SIR, and for ASDINDon Schon, M.D., Tim Pflederer, MD, Ted Saad, MD and Gerald Beathard, MD. Over a two-year period of time an exhaustive review of all of the major andmany of theminor codeswas undertaken. From this review, a thorough understanding of the history and evolution of the codes used in the past for these procedures was imparted to ASDIN. The concept that the original codes were conceived around grafts and that the current landscape required reevaluation for fistulas was imparted to SIR. These discussions resulted in compromises acceptable to both organizations. In addition, the committee studied and gained a thorough knowledge of the processes and committees involved in the analysis of reimbursement decisions. Parameters utilized in coding reviews by CMS and associated organizations and intermediaries were studied and taken into account in revising the Coding Manual. The Coding Committee felt that self policing of code utilization was a much more satisfactory process than having regulation imposed from outside agencies and organizations. The committee gained a great deal of respect for the importance of uniform coding practices and the importance of consistently following a set of standardized recommendations such as those represented in the Coding Manual. It is only by doing this that our Society will be able to speak in the future with a strong, unified voice in matters that relate to this very important aspect of our rapidly growing field. Included in this revision of the Coding Manual are discussions and recommendations relating to several new codes and especially the G codes issued by CMS for angioplasty procedures. The uses of examples within the manual and the illustrative cases at the end of the manual have been expanded. In addition an extensive discussion of modifiers and their use has been added. The purpose of this article is to provide an overview of the changes in this new revision of the Coding Manual. It is important that prior to implementing these changes you download the manual, study it and utilize its principles. The manual may be obtained from the members-only websites of The American Society of Diagnostic and Interventional Nephrology and The Renal Physicians Association.