LCD Reference Article Billing and Coding Article

Billing and Coding: Dialysis Access Maintenance

A56460

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Contractor Information

Contractor Name	Contract Type	Contract Number	Jurisdiction	States
CGS Administrators, LLC	MAC - Part A	15101 - MAC A	J - 15	Kentucky
CGS Administrators, LLC	MAC - Part B	15102 - MAC B	J - 15	Kentucky
CGS Administrators, LLC	MAC - Part A	15201 - MAC A	J - 15	Ohio
CGS Administrators, LLC	MAC - Part B	15202 - MAC B	J - 15	Ohio

Article Information

General Information

Article ID
A56460

Article Title
Billing and Coding: Dialysis Access Maintenance

Article Type
Billing and Coding

Original Effective Date
01/01/2018

Revision Effective Date
02/01/2024

Revision Ending Date
N/A

Retirement Date
N/A

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Copyright © 2024, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the AHA copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution, or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

N/A

Article Guidance

Article Text

This article gives guidance for billing, coding, and other guidelines in relation to local coverage policy L34062-Dialysis Access Maintenance.

General Guidelines for Claims submitted to Part A or Part B MAC:

Procedure codes may be subject to National Correct Coding Initiative (NCCI) edits or OPPS packaging edits. Refer to NCCI and OPPS requirements prior to billing Medicare. For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim. A claim submitted without a valid ICD-10-CM diagnosis code will be returned to the provider as an incomplete claim under Section 1833(e) of the Social Security Act. The diagnosis code(s) must best describe the patient's condition for which the service was performed. For diagnostic tests, report the result of the test if known; otherwise the symptoms prompting the performance of the test should be reported.

Advance Beneficiary Notice of Non-coverage (ABN) Modifier Guidelines

An ABN may be used for services which are likely to be non-covered, whether for medical necessity or for other reasons. Refer to CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 30, for complete instructions.

Effective from April 1, 2010, non-covered services should be billed with modifier –GA, -GX, -GY, or –GZ, as appropriate.

The –GA modifier (“Waiver of Liability Statement Issued as Required by Payer Policy”) should be used when physicians, practitioners, or suppliers want to indicate that they anticipate that Medicare will deny a specific service as not reasonable and necessary and they do have an ABN signed by the beneficiary on file. Modifier GA applies only when services will be denied under reasonable and necessary provisions, sections 1862(a)(1), 1862(a)(9), 1879(e), or 1879(g) of the Social Security Act. Effective April 1, 2010, Part A MAC systems will automatically deny services billed with modifier GA. An ABN, Form CMS-R-131, should be signed by the beneficiary to indicate that ‎he/she accepts responsibility for payment.‎ The -GA modifier may also be used on assigned claims when a patient refuses to sign the ABN and the latter is properly witnessed. For claims submitted to the Part A MAC, occurrence code 32 and the date of the ABN is required.

Modifier GX (“Notice of Liability Issued, Voluntary Under Payer Policy”) should be used when the beneficiary has signed an ABN, and a denial is anticipated based on provisions other than medical necessity, such as statutory exclusions of coverage or technical issues. An ABN is not required for these denials, but if non-covered services are reported with modifier GX, will automatically be denied services.

The –GZ modifier should be used when physicians, practitioners, or suppliers want to indicate that they expect that Medicare will deny an item or service as not reasonable and necessary and they have not had an ABN signed by the beneficiary. ‎If the service is statutorily non-covered, or without a benefit category, submit the ‎appropriate CPT/HCPCS code with the -GY modifier. An ABN is not required for these denials, and the limitation of liability does not apply for beneficiaries. Services with modifier GY will automatically deny.

Documentation Requirements

The patient’s medical record should include but is not limited to:

The assessment of the patient by the ordering provider as it relates to the complaint of the patient for that visit,
Relevant medical history
Results of pertinent tests/procedures
Signed and dated office visit record/operative report (Please note that all services ordered or rendered to Medicare beneficiaries must be signed.)

Response To Comments

Number	Comment	Response
1

Coding Information

Bill Type Codes

Code	Description
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Revenue Codes

Code	Description
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CPT/HCPCS Codes

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CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

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Group 1

(122 Codes)

Group 1 Paragraph

It is the responsibility of the provider to code to the highest level specified in the ICD-10-CM. The correct use of an ICD-10-CM code listed below does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in this determination.

36005, 36010, 36140, 36215, 36216, 36217, 36218, 36245, 36246, 36247, 36593, 36831, 36832, 36833, 36901, 36902, 36903, 36904, 36905, 36906, 36907, 37186, 37211, 37212, 37213, 37214, 37236, 37237, 37246, 37247, 37248, 37249, 75710, 75820, 75822, 75825, 75827

Group 1 Codes

Code	Description
I70.401 - I70.403	Unspecified atherosclerosis of autologous vein bypass graft(s) of the extremities, right leg - Unspecified atherosclerosis of autologous vein bypass graft(s) of the extremities, bilateral legs
I70.408	Unspecified atherosclerosis of autologous vein bypass graft(s) of the extremities, other extremity
I70.411 - I70.413	Atherosclerosis of autologous vein bypass graft(s) of the extremities with intermittent claudication, right leg - Atherosclerosis of autologous vein bypass graft(s) of the extremities with intermittent claudication, bilateral legs
I70.418	Atherosclerosis of autologous vein bypass graft(s) of the extremities with intermittent claudication, other extremity
I70.421 - I70.423	Atherosclerosis of autologous vein bypass graft(s) of the extremities with rest pain, right leg - Atherosclerosis of autologous vein bypass graft(s) of the extremities with rest pain, bilateral legs
I70.428	Atherosclerosis of autologous vein bypass graft(s) of the extremities with rest pain, other extremity
I70.431 - I70.435	Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of thigh - Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of other part of foot
I70.441 - I70.445	Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of thigh - Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of other part of foot
I70.45	Atherosclerosis of autologous vein bypass graft(s) of other extremity with ulceration
I70.461 - I70.463	Atherosclerosis of autologous vein bypass graft(s) of the extremities with gangrene, right leg - Atherosclerosis of autologous vein bypass graft(s) of the extremities with gangrene, bilateral legs
I70.468	Atherosclerosis of autologous vein bypass graft(s) of the extremities with gangrene, other extremity
I70.491 - I70.493	Other atherosclerosis of autologous vein bypass graft(s) of the extremities, right leg - Other atherosclerosis of autologous vein bypass graft(s) of the extremities, bilateral legs
I70.498	Other atherosclerosis of autologous vein bypass graft(s) of the extremities, other extremity
I70.501 - I70.503	Unspecified atherosclerosis of nonautologous biological bypass graft(s) of the extremities, right leg - Unspecified atherosclerosis of nonautologous biological bypass graft(s) of the extremities, bilateral legs
I70.508	Unspecified atherosclerosis of nonautologous biological bypass graft(s) of the extremities, other extremity
I70.511 - I70.513	Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with intermittent claudication, right leg - Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with intermittent claudication, bilateral legs
I70.518	Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with intermittent claudication, other extremity
I70.521 - I70.523	Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with rest pain, right leg - Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with rest pain, bilateral legs
I70.528	Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with rest pain, other extremity
I70.531 - I70.535	Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of thigh - Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of other part of foot
I70.541 - I70.545	Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of thigh - Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of other part of foot
I70.55	Atherosclerosis of nonautologous biological bypass graft(s) of other extremity with ulceration
I70.561 - I70.563	Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with gangrene, right leg - Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with gangrene, bilateral legs
I70.568	Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with gangrene, other extremity
I70.591 - I70.593	Other atherosclerosis of nonautologous biological bypass graft(s) of the extremities, right leg - Other atherosclerosis of nonautologous biological bypass graft(s) of the extremities, bilateral legs
I70.598	Other atherosclerosis of nonautologous biological bypass graft(s) of the extremities, other extremity
I72.1	Aneurysm of artery of upper extremity
I72.4	Aneurysm of artery of lower extremity
I74.2	Embolism and thrombosis of arteries of the upper extremities
I74.3	Embolism and thrombosis of arteries of the lower extremities
I77.0	Arteriovenous fistula, acquired
I77.1	Stricture of artery
I80.8	Phlebitis and thrombophlebitis of other sites
I82.611 - I82.613	Acute embolism and thrombosis of superficial veins of right upper extremity - Acute embolism and thrombosis of superficial veins of upper extremity, bilateral
I87.1	Compression of vein
M79.89	Other specified soft tissue disorders
N18.6	End stage renal disease
T82.310A	Breakdown (mechanical) of aortic (bifurcation) graft (replacement), initial encounter
T82.311A	Breakdown (mechanical) of carotid arterial graft (bypass), initial encounter
T82.312A	Breakdown (mechanical) of femoral arterial graft (bypass), initial encounter
T82.318A	Breakdown (mechanical) of other vascular grafts, initial encounter
T82.320A	Displacement of aortic (bifurcation) graft (replacement), initial encounter
T82.321A	Displacement of carotid arterial graft (bypass), initial encounter
T82.322A	Displacement of femoral arterial graft (bypass), initial encounter
T82.328A	Displacement of other vascular grafts, initial encounter
T82.330A	Leakage of aortic (bifurcation) graft (replacement), initial encounter
T82.331A	Leakage of carotid arterial graft (bypass), initial encounter
T82.332A	Leakage of femoral arterial graft (bypass), initial encounter
T82.338A	Leakage of other vascular grafts, initial encounter
T82.390A	Other mechanical complication of aortic (bifurcation) graft (replacement), initial encounter
T82.391A	Other mechanical complication of carotid arterial graft (bypass), initial encounter
T82.392A	Other mechanical complication of femoral arterial graft (bypass), initial encounter
T82.398A	Other mechanical complication of other vascular grafts, initial encounter
T82.41XA	Breakdown (mechanical) of vascular dialysis catheter, initial encounter
T82.42XA	Displacement of vascular dialysis catheter, initial encounter
T82.43XA	Leakage of vascular dialysis catheter, initial encounter
T82.49XA	Other complication of vascular dialysis catheter, initial encounter
T82.510A	Breakdown (mechanical) of surgically created arteriovenous fistula, initial encounter
T82.511A	Breakdown (mechanical) of surgically created arteriovenous shunt, initial encounter
T82.513A	Breakdown (mechanical) of balloon (counterpulsation) device, initial encounter
T82.514A	Breakdown (mechanical) of infusion catheter, initial encounter
T82.515A	Breakdown (mechanical) of umbrella device, initial encounter
T82.518A	Breakdown (mechanical) of other cardiac and vascular devices and implants, initial encounter
T82.520A	Displacement of surgically created arteriovenous fistula, initial encounter
T82.521A	Displacement of surgically created arteriovenous shunt, initial encounter
T82.523A	Displacement of balloon (counterpulsation) device, initial encounter
T82.524A	Displacement of infusion catheter, initial encounter
T82.525A	Displacement of umbrella device, initial encounter
T82.528A	Displacement of other cardiac and vascular devices and implants, initial encounter
T82.529A	Displacement of unspecified cardiac and vascular devices and implants, initial encounter
T82.530A	Leakage of surgically created arteriovenous fistula, initial encounter
T82.531A	Leakage of surgically created arteriovenous shunt, initial encounter
T82.533A	Leakage of balloon (counterpulsation) device, initial encounter
T82.534A	Leakage of infusion catheter, initial encounter
T82.535A	Leakage of umbrella device, initial encounter
T82.538A	Leakage of other cardiac and vascular devices and implants, initial encounter
T82.590A	Other mechanical complication of surgically created arteriovenous fistula, initial encounter
T82.591A	Other mechanical complication of surgically created arteriovenous shunt, initial encounter
T82.593A	Other mechanical complication of balloon (counterpulsation) device, initial encounter
T82.594A	Other mechanical complication of infusion catheter, initial encounter
T82.595A	Other mechanical complication of umbrella device, initial encounter
T82.598A	Other mechanical complication of other cardiac and vascular devices and implants, initial encounter
T82.7XXA	Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, initial encounter
Z99.2	Dependence on renal dialysis

Group 2

(7 Codes)

Group 2 Paragraph

36005, 36010, 36140, 36215, 36216, 36217, 36218, 36245, 36246, 36247, 36593, 36831, 36832, 36833, 36901, 36902, 36903, 36904, 36905, 36906, 36907, 37186, 37211, 37212, 37213, 37214, 37236, 37237, 37246, 37247, 37248, 37249, 75710, 75820, 75822, 75825, 75827

ICD-10-CM codes are the codes that describes ESRD with malfunctioning dialysis access (grafts or fistulae).

Group 2 Codes

Code	Description
T82.818A	Embolism due to vascular prosthetic devices, implants and grafts, initial encounter
T82.828A	Fibrosis due to vascular prosthetic devices, implants and grafts, initial encounter
T82.838A	Hemorrhage due to vascular prosthetic devices, implants and grafts, initial encounter
T82.848A	Pain due to vascular prosthetic devices, implants and grafts, initial encounter
T82.858A	Stenosis of other vascular prosthetic devices, implants and grafts, initial encounter
T82.868A	Thrombosis due to vascular prosthetic devices, implants and grafts, initial encounter
T82.898A	Other specified complication of vascular prosthetic devices, implants and grafts, initial encounter

Group 3

(17 Codes)

Group 3 Paragraph

93990

Group 3 Codes

Code	Description
I77.0	Arteriovenous fistula, acquired
I97.89	Other postprocedural complications and disorders of the circulatory system, not elsewhere classified
T82.818A	Embolism due to vascular prosthetic devices, implants and grafts, initial encounter
T82.818S	Embolism due to vascular prosthetic devices, implants and grafts, sequela
T82.828A	Fibrosis due to vascular prosthetic devices, implants and grafts, initial encounter
T82.828S	Fibrosis due to vascular prosthetic devices, implants and grafts, sequela
T82.838A	Hemorrhage due to vascular prosthetic devices, implants and grafts, initial encounter
T82.838S	Hemorrhage due to vascular prosthetic devices, implants and grafts, sequela
T82.848A	Pain due to vascular prosthetic devices, implants and grafts, initial encounter
T82.848S	Pain due to vascular prosthetic devices, implants and grafts, sequela
T82.858A	Stenosis of other vascular prosthetic devices, implants and grafts, initial encounter
T82.858S	Stenosis of other vascular prosthetic devices, implants and grafts, sequela
T82.868A	Thrombosis due to vascular prosthetic devices, implants and grafts, initial encounter
T82.868S	Thrombosis due to vascular prosthetic devices, implants and grafts, sequela
T82.898A	Other specified complication of vascular prosthetic devices, implants and grafts, initial encounter
T82.898S	Other specified complication of vascular prosthetic devices, implants and grafts, sequela
Z99.2	Dependence on renal dialysis

ICD-10-CM Codes that DO NOT Support Medical Necessity

N/A

ICD-10-PCS Codes

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code	Description
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Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Revenue codes only apply to providers who bill these services to the Part A MAC. Revenue codes do not apply to physicians, other professionals and suppliers who bill these services to the carrier or Part B MAC.

Please note that not all revenue codes apply to every type of bill code. Providers are encouraged to refer to the FISS revenue code file for allowable bill types. Similarly, not all revenue codes apply to each CPT/HCPCS code. Providers are encouraged to refer to the FISS HCPCS file for allowable revenue codes.

All revenue codes billed on the inpatient claim for the dates of service in question may be subject to review.

Code	Description
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Other Coding Information

N/A

Coding Table Information

Excluded CPT/HCPCS Codes - Table Format

Code	Descriptor Generic Name	Descriptor Brand Name	Exclusion Effective Date	Exclusion End Date	Reason for Exclusion
			N/A	N/A

Non-Excluded CPT/HCPCS Ended Codes - Table Format

Code	Descriptor Generic Name	Descriptor Brand Name	Exclusion Effective Date	Exclusion End Date	Reason for Exclusion

Revision History Information

Revision History Date	Revision History Number	Revision History Explanation
02/01/2024	R8	Revision Effective: 02/01/2024 Revision Explanation: Annual review, no changes were made.
11/16/2023	R7	Revision Effective: 11/16/2023 Revision Explanation: Updated LCD Reference Article section.
02/09/2023	R6	Revision Effective: 02/09/2023 Revision Explanation: Annual Review, no changes were made.
02/10/2022	R5	Revision Effective: 02/10/2022 Revision Explanation: Annual Review, no changes were made
01/28/2021	R4	Revision Effective: 01/28/2021 Revision Explanation: Annual Review, no changes were made
09/19/2019	R3	Revision Effective: N/A Revision Explanation: Annual Review, no changes
09/19/2019	R2	R1 Revision Effective: 09/19/2019 Revision Explanation: Converted article into new Billing and Coding template no other changes made.
04/04/2019	R1	Added Group 2 paragraph.

Associated Documents

Related Local Coverage Documents
LCDs
L34062 - Dialysis Access Maintenance

Updated On	Effective Dates	Status
01/25/2024	02/01/2024 - N/A	Currently in Effect	You are here
11/08/2023	11/16/2023 - 01/31/2024	Superseded	View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

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Billing and Coding: Dialysis Access Maintenance

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