An AV fistula — whether it is being accessed or not — does not meet the definition of IV Access for O0110O1 (Special Treatments, Procedures and Programs; Other - IV Access), CMS clarified in response to a question in the January 2024 quarterly OASIS Q&As. 
 
This was in response to the following scenario presented in the Q&A. “For a patient who has an AV fistula and IV access is temporarily obtained during hemodialysis at an outside dialysis center, would the IV access be considered for O0110O1 or would it be excluded since it is only accessed during dialysis, similar to the exclusions with medications and transfusions that were administered during dialysis in item O0110?” 
 
An AV fistula or graft is created by grafting together an artery and a vein, notes Ohio-based home health and coding expert Brandi Whitemyer. “It is not truly an intravenous infusion access point, but rather an arteriovenous graft point,” she adds.  
 
Some patients, at the discretion of their physician, have dialysis access via a central line implanted in the chest or jugular vein, Whitemyer says. This type of access, a central venous catheter specifically for dialysis (HD-CVC), can be tunneled or non-tunneled depending on the duration of dialysis expected and has multiple ports and a lumen with a larger diameter than that of a typical central venous catheter. 
 
The larger lumen size allows for infusion and the desired extracorporeal blood flow of 300-400ml/min necessary for dialysis, she adds. 
 
“An AV fistula is not a central venous catheter, and it is not an IV access,” Whitemyer says. “It's something totally different of its own, regardless of whether or not it is accessed and this part of the O0110 item is not referring to access of these types of vascular access points.”
 
This was one of just two questions included in this shorter batch of OASIS Q&As — released Jan. 16. 
 
To view the full CMS’ January 2024 quarterly OASIS Q&As, visit http://tinyurl.com/mu6m5tjt. For a full story, see upcoming issues of Home Health Line and Diagnosis Coding Pro for Home Health.