# 93990- Duplex scan of hemodialysis access



## apogoreski (Mar 1, 2013)

Our PA is having a disagreement with some of the Dialysis Centers on the billing for the 93990, ultrasound surveillance for a fistula. Some of the centers state that other physicians are performing this once a month but he is concerned about frequency issues. Has anyone ever come across any issues with billing this procedure? I'm having a hard time finding any frequency guidelines for this and just want to make sure everything correct before reporting back to our PA.


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## djh803 (Mar 1, 2013)

CMS bundles this service in the payment made to the Dialysis Center. To be paid for surveillance of the fistula, you will need to bill the Dialysis Center. The following is quoted from the Local Coverage Determination of Novitas Solutions which is the Jurisdiction 12 & Jurisdiction H Medicare Administrative Contractor:

"Coverage Limitations: 

Non-invasive vascular studies are not covered as a separately billable service if used to monitor a patient’s vascular access site. Medicare pays for the technical component of the procedure in the composite payment rate for ESRD patients.

 An ESRD facility must furnish all necessary services, equipment and supplies associated with a dialysis treatment either directly or under arrangements that make the facility financially responsible for the service. If an ESRD facility or a renal physician decides to monitor the patient’s access site with a non-invasive vascular study and does not have the equipment to perform the procedure, the facility or physician may arrange for the service to be furnished by another source. The alternative source, such as an independent diagnostic testing facility, must look to the ESRD facility for payment. No separate payment for non-invasive vascular studies for monitoring the access site of an ESRD patient, whether coded as the access site or peripheral site, is permitted to any entity."

Hope this helps.


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