Local Coverage Article Billing and Coding

Billing and Coding: Non-Invasive Peripheral Venous Studies

A52993

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Article ID
A52993
Article Title
Billing and Coding: Non-Invasive Peripheral Venous Studies
Article Type
Billing and Coding
Original Effective Date
10/01/2015
Revision Effective Date
03/18/2021
Revision Ending Date
N/A
Retirement Date
N/A
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  • Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.

Article Guidance

Article Text

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD), L35451 Non-Invasive Peripheral Venous Studies. Please refer to the LCD for reasonable and necessary requirements.

Coding Guidance

Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier.

Note: When an uninterpretable study results in performing another type of study, only the successful study should be billed.

To report non-invasive peripheral venous studies for select medically necessary preoperative examinations use:

CPT code 93971 (Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study) for the following:

  • Preoperative examination of potential harvest vein grafts to be used during bypass surgery.
    • The need for bypass surgery must be determined prior to performance of the test.
    • Only one preoperative scan is covered for bypass surgery.
    • Use ICD-10-CM code Z01.810 when reporting this procedure.

CPT codes: 93985 (Ultrasound scan of blood flow in extremity on both sides of body for preoperative assessment of blood vessel for dialysis access) and 93986 (Ultrasound scan of blood flow in extremity on one side for preoperative assessment of blood vessel for dialysis access) for the following:

  • Preoperative examination of vessels prior to hemodialysis access site surgery in patients with end stage renal disease.
    • The need for a hemodialysis access site must be determined prior to performance of the test.
    • Only one preoperative scan is covered per hemodialysis access site surgery.
    • Use ICD-10-CM code Z01.818 when reporting this procedure with an eligible secondary diagnosis.

As noted above, correct coding guidelines indicate that CPT code 93971 should be used to report either a limited bilateral or a complete unilateral study (only one service should be reported). It would not be appropriate to report -50 modifier with CPT code 93971 for a limited bilateral study.

The CPT code 93970 is described as a “complete bilateral study.” The CPT code 93971 states: “unilateral or limited study.” Both codes can be used for bilateral studies; 93970 for complete, and 93971 for limited. If a complete or limited bilateral study is done on both the upper and the lower extremities, the corresponding code can be reported once for each study performed (i.e., once for the upper extremities and once for the lower extremities). Providers should append modifier 76, repeat service by the same provider, or modifier 77, repeat service by another provider, to the second code to indicate that two separate, distinct studies were performed. There should be a separate written report/interpretation for each study performed.

Note: Effective 1/1/2017, the CPT code 93965 has been deleted with the annual CPT/HCPCS code updates. There is no replacement code for CPT code 93965. It would be inappropriate to report a “not otherwise classified” (NOC) code for this service (Noninvasive physiologic studies of extremity veins, complete bilateral study [eg, doppler waveform analysis with responses to compression and other maneuvers, phleborheography, impedance plethysmography]).

ICD-10-CM diagnosis code Z13.9 (special screening of other conditions, unspecified condition) should be used to indicate screening tests performed in the absence of a specific sign, symptom, or complaint.

Use ICD-10-CM code Z09 only to describe a limited venous duplex (CPT code 93971) performed within 72 hours of a saphenous vein ablation procedure (CPT codes 36473, 36474, 36475, 36476, 36478, 36479, 36482, or 36483). 

Coding Information

CPT/HCPCS Codes

Group 1

(2 Codes)
Group 1 Paragraph

Note: Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book.

Group 1 Codes
CodeDescription
93970 Extremity study
93971 Extremity study

Group 2

(2 Codes)
Group 2 Paragraph

N/A

Group 2 Codes
CodeDescription
93985 Dup-scan hemo compl bi std
93986 Dup-scan hemo compl uni std

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(336 Codes)
Group 1 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 93970 and 93971.

Group 1 Codes
CodeDescription
I26.01 Septic pulmonary embolism with acute cor pulmonale
I26.02 Saddle embolus of pulmonary artery with acute cor pulmonale
I26.09 Other pulmonary embolism with acute cor pulmonale
I26.90 Septic pulmonary embolism without acute cor pulmonale
I26.92 Saddle embolus of pulmonary artery without acute cor pulmonale
I26.93 Single subsegmental pulmonary embolism without acute cor pulmonale
I26.94 Multiple subsegmental pulmonary emboli without acute cor pulmonale
I26.99 Other pulmonary embolism without acute cor pulmonale
I74.9* Embolism and thrombosis of unspecified artery
I80.01 Phlebitis and thrombophlebitis of superficial vessels of right lower extremity
I80.02 Phlebitis and thrombophlebitis of superficial vessels of left lower extremity
I80.03 Phlebitis and thrombophlebitis of superficial vessels of lower extremities, bilateral
I80.11 Phlebitis and thrombophlebitis of right femoral vein
I80.12 Phlebitis and thrombophlebitis of left femoral vein
I80.13 Phlebitis and thrombophlebitis of femoral vein, bilateral
I80.211 Phlebitis and thrombophlebitis of right iliac vein
I80.212 Phlebitis and thrombophlebitis of left iliac vein
I80.213 Phlebitis and thrombophlebitis of iliac vein, bilateral
I80.221 Phlebitis and thrombophlebitis of right popliteal vein
I80.222 Phlebitis and thrombophlebitis of left popliteal vein
I80.223 Phlebitis and thrombophlebitis of popliteal vein, bilateral
I80.231 Phlebitis and thrombophlebitis of right tibial vein
I80.232 Phlebitis and thrombophlebitis of left tibial vein
I80.233 Phlebitis and thrombophlebitis of tibial vein, bilateral
I80.241 Phlebitis and thrombophlebitis of right peroneal vein
I80.242 Phlebitis and thrombophlebitis of left peroneal vein
I80.243 Phlebitis and thrombophlebitis of peroneal vein, bilateral
I80.251 Phlebitis and thrombophlebitis of right calf muscular vein
I80.252 Phlebitis and thrombophlebitis of left calf muscular vein
I80.253 Phlebitis and thrombophlebitis of calf muscular vein, bilateral
I80.291 Phlebitis and thrombophlebitis of other deep vessels of right lower extremity
I80.292 Phlebitis and thrombophlebitis of other deep vessels of left lower extremity
I80.293 Phlebitis and thrombophlebitis of other deep vessels of lower extremity, bilateral
I80.8 Phlebitis and thrombophlebitis of other sites
I82.1 Thrombophlebitis migrans
I82.220 Acute embolism and thrombosis of inferior vena cava
I82.411 Acute embolism and thrombosis of right femoral vein
I82.412 Acute embolism and thrombosis of left femoral vein
I82.413 Acute embolism and thrombosis of femoral vein, bilateral
I82.421 Acute embolism and thrombosis of right iliac vein
I82.422 Acute embolism and thrombosis of left iliac vein
I82.423 Acute embolism and thrombosis of iliac vein, bilateral
I82.431 Acute embolism and thrombosis of right popliteal vein
I82.432 Acute embolism and thrombosis of left popliteal vein
I82.433 Acute embolism and thrombosis of popliteal vein, bilateral
I82.441 Acute embolism and thrombosis of right tibial vein
I82.442 Acute embolism and thrombosis of left tibial vein
I82.443 Acute embolism and thrombosis of tibial vein, bilateral
I82.451 Acute embolism and thrombosis of right peroneal vein
I82.452 Acute embolism and thrombosis of left peroneal vein
I82.453 Acute embolism and thrombosis of peroneal vein, bilateral
I82.461 Acute embolism and thrombosis of right calf muscular vein
I82.462 Acute embolism and thrombosis of left calf muscular vein
I82.463 Acute embolism and thrombosis of calf muscular vein, bilateral
I82.491 Acute embolism and thrombosis of other specified deep vein of right lower extremity
I82.492 Acute embolism and thrombosis of other specified deep vein of left lower extremity
I82.493 Acute embolism and thrombosis of other specified deep vein of lower extremity, bilateral
I82.511 Chronic embolism and thrombosis of right femoral vein
I82.512 Chronic embolism and thrombosis of left femoral vein
I82.513 Chronic embolism and thrombosis of femoral vein, bilateral
I82.521 Chronic embolism and thrombosis of right iliac vein
I82.522 Chronic embolism and thrombosis of left iliac vein
I82.523 Chronic embolism and thrombosis of iliac vein, bilateral
I82.531 Chronic embolism and thrombosis of right popliteal vein
I82.532 Chronic embolism and thrombosis of left popliteal vein
I82.533 Chronic embolism and thrombosis of popliteal vein, bilateral
I82.541 Chronic embolism and thrombosis of right tibial vein
I82.542 Chronic embolism and thrombosis of left tibial vein
I82.543 Chronic embolism and thrombosis of tibial vein, bilateral
I82.551 Chronic embolism and thrombosis of right peroneal vein
I82.552 Chronic embolism and thrombosis of left peroneal vein
I82.553 Chronic embolism and thrombosis of peroneal vein, bilateral
I82.561 Chronic embolism and thrombosis of right calf muscular vein
I82.562 Chronic embolism and thrombosis of left calf muscular vein
I82.563 Chronic embolism and thrombosis of calf muscular vein, bilateral
I82.591 Chronic embolism and thrombosis of other specified deep vein of right lower extremity
I82.592 Chronic embolism and thrombosis of other specified deep vein of left lower extremity
I82.593 Chronic embolism and thrombosis of other specified deep vein of lower extremity, bilateral
I82.611 Acute embolism and thrombosis of superficial veins of right upper extremity
I82.612 Acute embolism and thrombosis of superficial veins of left upper extremity
I82.613 Acute embolism and thrombosis of superficial veins of upper extremity, bilateral
I82.621 Acute embolism and thrombosis of deep veins of right upper extremity
I82.622 Acute embolism and thrombosis of deep veins of left upper extremity
I82.623 Acute embolism and thrombosis of deep veins of upper extremity, bilateral
I82.711 Chronic embolism and thrombosis of superficial veins of right upper extremity
I82.712 Chronic embolism and thrombosis of superficial veins of left upper extremity
I82.713 Chronic embolism and thrombosis of superficial veins of upper extremity, bilateral
I82.721 Chronic embolism and thrombosis of deep veins of right upper extremity
I82.722 Chronic embolism and thrombosis of deep veins of left upper extremity
I82.723 Chronic embolism and thrombosis of deep veins of upper extremity, bilateral
I82.A11 Acute embolism and thrombosis of right axillary vein
I82.A12 Acute embolism and thrombosis of left axillary vein
I82.A13 Acute embolism and thrombosis of axillary vein, bilateral
I82.A21 Chronic embolism and thrombosis of right axillary vein
I82.A22 Chronic embolism and thrombosis of left axillary vein
I82.A23 Chronic embolism and thrombosis of axillary vein, bilateral
I82.C11 Acute embolism and thrombosis of right internal jugular vein
I82.C12 Acute embolism and thrombosis of left internal jugular vein
I82.C13 Acute embolism and thrombosis of internal jugular vein, bilateral
I82.C21 Chronic embolism and thrombosis of right internal jugular vein
I82.C22 Chronic embolism and thrombosis of left internal jugular vein
I82.C23 Chronic embolism and thrombosis of internal jugular vein, bilateral
I82.811 Embolism and thrombosis of superficial veins of right lower extremity
I82.812 Embolism and thrombosis of superficial veins of left lower extremity
I82.813 Embolism and thrombosis of superficial veins of lower extremities, bilateral
I82.890 Acute embolism and thrombosis of other specified veins
I82.891 Chronic embolism and thrombosis of other specified veins
I83.011 Varicose veins of right lower extremity with ulcer of thigh
I83.012 Varicose veins of right lower extremity with ulcer of calf
I83.013 Varicose veins of right lower extremity with ulcer of ankle
I83.014 Varicose veins of right lower extremity with ulcer of heel and midfoot
I83.015 Varicose veins of right lower extremity with ulcer other part of foot
I83.018 Varicose veins of right lower extremity with ulcer other part of lower leg
I83.021 Varicose veins of left lower extremity with ulcer of thigh
I83.022 Varicose veins of left lower extremity with ulcer of calf
I83.023 Varicose veins of left lower extremity with ulcer of ankle
I83.024 Varicose veins of left lower extremity with ulcer of heel and midfoot
I83.025 Varicose veins of left lower extremity with ulcer other part of foot
I83.028 Varicose veins of left lower extremity with ulcer other part of lower leg
I83.11 Varicose veins of right lower extremity with inflammation
I83.12 Varicose veins of left lower extremity with inflammation
I83.211 Varicose veins of right lower extremity with both ulcer of thigh and inflammation
I83.212 Varicose veins of right lower extremity with both ulcer of calf and inflammation
I83.213 Varicose veins of right lower extremity with both ulcer of ankle and inflammation
I83.214 Varicose veins of right lower extremity with both ulcer of heel and midfoot and inflammation
I83.215 Varicose veins of right lower extremity with both ulcer other part of foot and inflammation
I83.218 Varicose veins of right lower extremity with both ulcer of other part of lower extremity and inflammation
I83.221 Varicose veins of left lower extremity with both ulcer of thigh and inflammation
I83.222 Varicose veins of left lower extremity with both ulcer of calf and inflammation
I83.223 Varicose veins of left lower extremity with both ulcer of ankle and inflammation
I83.224 Varicose veins of left lower extremity with both ulcer of heel and midfoot and inflammation
I83.225 Varicose veins of left lower extremity with both ulcer other part of foot and inflammation
I83.228 Varicose veins of left lower extremity with both ulcer of other part of lower extremity and inflammation
I83.811 Varicose veins of right lower extremity with pain
I83.812 Varicose veins of left lower extremity with pain
I83.813 Varicose veins of bilateral lower extremities with pain
I83.891 Varicose veins of right lower extremity with other complications
I83.892 Varicose veins of left lower extremity with other complications
I83.893 Varicose veins of bilateral lower extremities with other complications
I87.001 Postthrombotic syndrome without complications of right lower extremity
I87.002 Postthrombotic syndrome without complications of left lower extremity
I87.003 Postthrombotic syndrome without complications of bilateral lower extremity
I87.011 Postthrombotic syndrome with ulcer of right lower extremity
I87.012 Postthrombotic syndrome with ulcer of left lower extremity
I87.013 Postthrombotic syndrome with ulcer of bilateral lower extremity
I87.021 Postthrombotic syndrome with inflammation of right lower extremity
I87.022 Postthrombotic syndrome with inflammation of left lower extremity
I87.023 Postthrombotic syndrome with inflammation of bilateral lower extremity
I87.031 Postthrombotic syndrome with ulcer and inflammation of right lower extremity
I87.032 Postthrombotic syndrome with ulcer and inflammation of left lower extremity
I87.033 Postthrombotic syndrome with ulcer and inflammation of bilateral lower extremity
I87.091 Postthrombotic syndrome with other complications of right lower extremity
I87.092 Postthrombotic syndrome with other complications of left lower extremity
I87.093 Postthrombotic syndrome with other complications of bilateral lower extremity
I87.1 Compression of vein
I87.2 Venous insufficiency (chronic) (peripheral)
I87.301 Chronic venous hypertension (idiopathic) without complications of right lower extremity
I87.302 Chronic venous hypertension (idiopathic) without complications of left lower extremity
I87.303 Chronic venous hypertension (idiopathic) without complications of bilateral lower extremity
I87.311 Chronic venous hypertension (idiopathic) with ulcer of right lower extremity
I87.312 Chronic venous hypertension (idiopathic) with ulcer of left lower extremity
I87.313 Chronic venous hypertension (idiopathic) with ulcer of bilateral lower extremity
I87.321 Chronic venous hypertension (idiopathic) with inflammation of right lower extremity
I87.322 Chronic venous hypertension (idiopathic) with inflammation of left lower extremity
I87.323 Chronic venous hypertension (idiopathic) with inflammation of bilateral lower extremity
I87.331 Chronic venous hypertension (idiopathic) with ulcer and inflammation of right lower extremity
I87.332 Chronic venous hypertension (idiopathic) with ulcer and inflammation of left lower extremity
I87.333 Chronic venous hypertension (idiopathic) with ulcer and inflammation of bilateral lower extremity
I87.391 Chronic venous hypertension (idiopathic) with other complications of right lower extremity
I87.392 Chronic venous hypertension (idiopathic) with other complications of left lower extremity
I87.393 Chronic venous hypertension (idiopathic) with other complications of bilateral lower extremity
I96 Gangrene, not elsewhere classified
J80 Acute respiratory distress syndrome
J96.00 Acute respiratory failure, unspecified whether with hypoxia or hypercapnia
J96.01 Acute respiratory failure with hypoxia
J96.02 Acute respiratory failure with hypercapnia
J96.90 Respiratory failure, unspecified, unspecified whether with hypoxia or hypercapnia
L97.111 Non-pressure chronic ulcer of right thigh limited to breakdown of skin
L97.112 Non-pressure chronic ulcer of right thigh with fat layer exposed
L97.113 Non-pressure chronic ulcer of right thigh with necrosis of muscle
L97.114 Non-pressure chronic ulcer of right thigh with necrosis of bone
L97.115 Non-pressure chronic ulcer of right thigh with muscle involvement without evidence of necrosis
L97.116 Non-pressure chronic ulcer of right thigh with bone involvement without evidence of necrosis
L97.118 Non-pressure chronic ulcer of right thigh with other specified severity
L97.119 Non-pressure chronic ulcer of right thigh with unspecified severity
L97.121 Non-pressure chronic ulcer of left thigh limited to breakdown of skin
L97.122 Non-pressure chronic ulcer of left thigh with fat layer exposed
L97.123 Non-pressure chronic ulcer of left thigh with necrosis of muscle
L97.124 Non-pressure chronic ulcer of left thigh with necrosis of bone
L97.125 Non-pressure chronic ulcer of left thigh with muscle involvement without evidence of necrosis
L97.126 Non-pressure chronic ulcer of left thigh with bone involvement without evidence of necrosis
L97.128 Non-pressure chronic ulcer of left thigh with other specified severity
L97.129 Non-pressure chronic ulcer of left thigh with unspecified severity
L97.211 Non-pressure chronic ulcer of right calf limited to breakdown of skin
L97.212 Non-pressure chronic ulcer of right calf with fat layer exposed
L97.213 Non-pressure chronic ulcer of right calf with necrosis of muscle
L97.214 Non-pressure chronic ulcer of right calf with necrosis of bone
L97.215 Non-pressure chronic ulcer of right calf with muscle involvement without evidence of necrosis
L97.216 Non-pressure chronic ulcer of right calf with bone involvement without evidence of necrosis
L97.218 Non-pressure chronic ulcer of right calf with other specified severity
L97.219 Non-pressure chronic ulcer of right calf with unspecified severity
L97.221 Non-pressure chronic ulcer of left calf limited to breakdown of skin
L97.222 Non-pressure chronic ulcer of left calf with fat layer exposed
L97.223 Non-pressure chronic ulcer of left calf with necrosis of muscle
L97.224 Non-pressure chronic ulcer of left calf with necrosis of bone
L97.225 Non-pressure chronic ulcer of left calf with muscle involvement without evidence of necrosis
L97.226 Non-pressure chronic ulcer of left calf with bone involvement without evidence of necrosis
L97.228 Non-pressure chronic ulcer of left calf with other specified severity
L97.229 Non-pressure chronic ulcer of left calf with unspecified severity
L97.311 Non-pressure chronic ulcer of right ankle limited to breakdown of skin
L97.312 Non-pressure chronic ulcer of right ankle with fat layer exposed
L97.313 Non-pressure chronic ulcer of right ankle with necrosis of muscle
L97.314 Non-pressure chronic ulcer of right ankle with necrosis of bone
L97.315 Non-pressure chronic ulcer of right ankle with muscle involvement without evidence of necrosis
L97.316 Non-pressure chronic ulcer of right ankle with bone involvement without evidence of necrosis
L97.318 Non-pressure chronic ulcer of right ankle with other specified severity
L97.319 Non-pressure chronic ulcer of right ankle with unspecified severity
L97.321 Non-pressure chronic ulcer of left ankle limited to breakdown of skin
L97.322 Non-pressure chronic ulcer of left ankle with fat layer exposed
L97.323 Non-pressure chronic ulcer of left ankle with necrosis of muscle
L97.324 Non-pressure chronic ulcer of left ankle with necrosis of bone
L97.325 Non-pressure chronic ulcer of left ankle with muscle involvement without evidence of necrosis
L97.326 Non-pressure chronic ulcer of left ankle with bone involvement without evidence of necrosis
L97.328 Non-pressure chronic ulcer of left ankle with other specified severity
L97.329 Non-pressure chronic ulcer of left ankle with unspecified severity
L97.411 Non-pressure chronic ulcer of right heel and midfoot limited to breakdown of skin
L97.412 Non-pressure chronic ulcer of right heel and midfoot with fat layer exposed
L97.413 Non-pressure chronic ulcer of right heel and midfoot with necrosis of muscle
L97.414 Non-pressure chronic ulcer of right heel and midfoot with necrosis of bone
L97.415 Non-pressure chronic ulcer of right heel and midfoot with muscle involvement without evidence of necrosis
L97.416 Non-pressure chronic ulcer of right heel and midfoot with bone involvement without evidence of necrosis
L97.418 Non-pressure chronic ulcer of right heel and midfoot with other specified severity
L97.419 Non-pressure chronic ulcer of right heel and midfoot with unspecified severity
L97.421 Non-pressure chronic ulcer of left heel and midfoot limited to breakdown of skin
L97.422 Non-pressure chronic ulcer of left heel and midfoot with fat layer exposed
L97.423 Non-pressure chronic ulcer of left heel and midfoot with necrosis of muscle
L97.424 Non-pressure chronic ulcer of left heel and midfoot with necrosis of bone
L97.425 Non-pressure chronic ulcer of left heel and midfoot with muscle involvement without evidence of necrosis
L97.426 Non-pressure chronic ulcer of left heel and midfoot with bone involvement without evidence of necrosis
L97.428 Non-pressure chronic ulcer of left heel and midfoot with other specified severity
L97.429 Non-pressure chronic ulcer of left heel and midfoot with unspecified severity
L97.511 Non-pressure chronic ulcer of other part of right foot limited to breakdown of skin
L97.512 Non-pressure chronic ulcer of other part of right foot with fat layer exposed
L97.513 Non-pressure chronic ulcer of other part of right foot with necrosis of muscle
L97.514 Non-pressure chronic ulcer of other part of right foot with necrosis of bone
L97.515 Non-pressure chronic ulcer of other part of right foot with muscle involvement without evidence of necrosis
L97.516 Non-pressure chronic ulcer of other part of right foot with bone involvement without evidence of necrosis
L97.518 Non-pressure chronic ulcer of other part of right foot with other specified severity
L97.519 Non-pressure chronic ulcer of other part of right foot with unspecified severity
L97.521 Non-pressure chronic ulcer of other part of left foot limited to breakdown of skin
L97.522 Non-pressure chronic ulcer of other part of left foot with fat layer exposed
L97.523 Non-pressure chronic ulcer of other part of left foot with necrosis of muscle
L97.524 Non-pressure chronic ulcer of other part of left foot with necrosis of bone
L97.525 Non-pressure chronic ulcer of other part of left foot with muscle involvement without evidence of necrosis
L97.526 Non-pressure chronic ulcer of other part of left foot with bone involvement without evidence of necrosis
L97.528 Non-pressure chronic ulcer of other part of left foot with other specified severity
L97.529 Non-pressure chronic ulcer of other part of left foot with unspecified severity
L97.811 Non-pressure chronic ulcer of other part of right lower leg limited to breakdown of skin
L97.812 Non-pressure chronic ulcer of other part of right lower leg with fat layer exposed
L97.813 Non-pressure chronic ulcer of other part of right lower leg with necrosis of muscle
L97.814 Non-pressure chronic ulcer of other part of right lower leg with necrosis of bone
L97.815 Non-pressure chronic ulcer of other part of right lower leg with muscle involvement without evidence of necrosis
L97.816 Non-pressure chronic ulcer of other part of right lower leg with bone involvement without evidence of necrosis
L97.818 Non-pressure chronic ulcer of other part of right lower leg with other specified severity
L97.819 Non-pressure chronic ulcer of other part of right lower leg with unspecified severity
L97.821 Non-pressure chronic ulcer of other part of left lower leg limited to breakdown of skin
L97.822 Non-pressure chronic ulcer of other part of left lower leg with fat layer exposed
L97.823 Non-pressure chronic ulcer of other part of left lower leg with necrosis of muscle
L97.824 Non-pressure chronic ulcer of other part of left lower leg with necrosis of bone
L97.825 Non-pressure chronic ulcer of other part of left lower leg with muscle involvement without evidence of necrosis
L97.826 Non-pressure chronic ulcer of other part of left lower leg with bone involvement without evidence of necrosis
L97.828 Non-pressure chronic ulcer of other part of left lower leg with other specified severity
L97.829 Non-pressure chronic ulcer of other part of left lower leg with unspecified severity
M71.21 Synovial cyst of popliteal space [Baker], right knee
M71.22 Synovial cyst of popliteal space [Baker], left knee
M79.601 Pain in right arm
M79.602 Pain in left arm
M79.604 Pain in right leg
M79.605 Pain in left leg
M79.621 Pain in right upper arm
M79.622 Pain in left upper arm
M79.631 Pain in right forearm
M79.632 Pain in left forearm
M79.641 Pain in right hand
M79.642 Pain in left hand
M79.644 Pain in right finger(s)
M79.645 Pain in left finger(s)
M79.651 Pain in right thigh
M79.652 Pain in left thigh
M79.661 Pain in right lower leg
M79.662 Pain in left lower leg
M79.671 Pain in right foot
M79.672 Pain in left foot
M79.674 Pain in right toe(s)
M79.675 Pain in left toe(s)
O22.21 Superficial thrombophlebitis in pregnancy, first trimester
O22.22 Superficial thrombophlebitis in pregnancy, second trimester
O22.23 Superficial thrombophlebitis in pregnancy, third trimester
O22.31 Deep phlebothrombosis in pregnancy, first trimester
O22.32 Deep phlebothrombosis in pregnancy, second trimester
O22.33 Deep phlebothrombosis in pregnancy, third trimester
O87.0 Superficial thrombophlebitis in the puerperium
O87.1 Deep phlebothrombosis in the puerperium
O88.211 Thromboembolism in pregnancy, first trimester
O88.212 Thromboembolism in pregnancy, second trimester
O88.213 Thromboembolism in pregnancy, third trimester
O88.22 Thromboembolism in childbirth
O88.23 Thromboembolism in the puerperium
Q27.31 Arteriovenous malformation of vessel of upper limb
Q27.32 Arteriovenous malformation of vessel of lower limb
Q27.8 Other specified congenital malformations of peripheral vascular system
R04.2 Hemoptysis
R06.00 Dyspnea, unspecified
R06.02 Shortness of breath
R06.09 Other forms of dyspnea
R06.82 Tachypnea, not elsewhere classified
R07.1 Chest pain on breathing
R07.81 Pleurodynia
R07.82 Intercostal pain
R07.89 Other chest pain
R07.9 Chest pain, unspecified
R22.31 Localized swelling, mass and lump, right upper limb
R22.32 Localized swelling, mass and lump, left upper limb
R22.33 Localized swelling, mass and lump, upper limb, bilateral
R22.41 Localized swelling, mass and lump, right lower limb
R22.42 Localized swelling, mass and lump, left lower limb
R22.43 Localized swelling, mass and lump, lower limb, bilateral
R60.0 Localized edema
R60.1 Generalized edema
R60.9 Edema, unspecified
T80.0XXA Air embolism following infusion, transfusion and therapeutic injection, initial encounter
T80.1XXA Vascular complications following infusion, transfusion and therapeutic injection, initial encounter
T81.72XA Complication of vein following a procedure, not elsewhere classified, initial encounter
Z01.810* Encounter for preprocedural cardiovascular examination
Z01.818* Encounter for other preprocedural examination
Z09* Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm
Group 1 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*NOTE: Use ICD-10-CM code I74.9 to report paradoxical embolism.

*NOTE: ICD-10-CM code Z01.810 is only covered for CPT code 93971.

*NOTE: ICD-10-CM code Z01.818 is covered for either CPT/HCPCS codes 93971, 93985 or 93986 only (Refer to Group 2 codes for CPT codes 93985 and 93986).

*NOTE: Use ICD-10-CM code Z09 only to describe a limited venous duplex (CPT code 93971) performed within 72 hours of a saphenous vein ablation procedure (CPT codes 36473, 36474, 36475, 36476, 36478, 36479, 36482, or 36483).

Group 2

(4 Codes)
Group 2 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 93985 and 93986.

Group 2 Codes
CodeDescription
N18.4 Chronic kidney disease, stage 4 (severe)
N18.5 Chronic kidney disease, stage 5
N18.6 End stage renal disease
Z01.818* Encounter for other preprocedural examination
Group 2 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*NOTE: CPT codes 93985 and 93986 reported with ICD-10-CM code Z01.818 requires a secondary diagnosis code of N18.4, N18.5, or N18.6.

*NOTE: ICD-10-CM code Z01.818 is covered for either CPT codes 93971, 93985 or 93986 only (Refer to Group 1 codes for CPT code 93971).

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

Group 1

(1 Code)
Group 1 Paragraph

All ICD-10 codes not listed under the "ICD-10 Codes that Support Medical Necessity" section of this article.

Group 1 Codes
CodeDescription
XX000 Not Applicable

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.

CodeDescription
011x Hospital Inpatient (Including Medicare Part A)
012x Hospital Inpatient (Medicare Part B only)
013x Hospital Outpatient
018x Hospital - Swing Beds
021x Skilled Nursing - Inpatient (Including Medicare Part A)
022x Skilled Nursing - Inpatient (Medicare Part B only)
023x Skilled Nursing - Outpatient
028x Skilled Nursing - Swing Beds
083x Ambulatory Surgery Center
085x Critical Access Hospital

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.

Note: The contractor has identified the Bill Type and Revenue Codes applicable for use with the CPT/HCPCS codes included in this article. Providers are reminded that not all CPT/HCPCS codes listed can be billed with all Bill Type and/or Revenue Codes listed. CPT/HCPCS codes are required to be billed with specific Bill Type and Revenue Codes. Providers are encouraged to refer to the CMS Internet-Only Manual (IOM) Pub. 100-04, Medicare Claims Processing Manual, for further guidance.


CodeDescription
0921 Other Diagnostic Services - Peripheral Vascular Lab

Other Coding Information

N/A

Revision History Information

Revision History DateRevision History NumberRevision History Explanation
03/18/2021 R10

Article revised and published on 5/13/2021 effective for dates of service on and after 3/18/2021 in response to an inquiry.

The following CPT codes have been added to the statement in the Article regarding the use of ICD-10-CM code Z09: 36473, 36474, 36482, and 36483. These CPT codes have been added to the asterisk note for “Group 1 for Medical Necessity” under ICD-10-CM codes Asterisk Explanation.

01/12/2021 R9

Article revised and published on 02/25/2021 effective for dates of service on and after 01/12/2021 in response to an inquiry to add ICD-10 codes I87.301, I87.302 and I87.303 to the ‘Group 1 Codes’ in the ‘ICD-10 Codes that Support Medical Necessity’ section.

08/13/2020 R8

Article revised and published on 08/13/2020 effective for dates of service on and after 08/13/2020 as a non-discretionary update to correct code descriptors for CPT codes 93985 and 93986 in ‘Coding Guidance’ section. Minor formatting changes have also been made through the coding section.

01/01/2020 R7

Article revised and published on 01/16/2020 effective for dates of service on and after 01/01/2020 to reflect the annual CPT/HCPCS code updates. The following CPT/HCPCS code(s) have been added to Group 2 Codes, ICD-10 Group 2 paragraphs and Groups 1 and 2 asterisk explanation: 93985 and 93986. The following CPT/HCPCS code(s) have been deleted from Group 2 codes, ICD-10 Group 2 paragraphs and Groups 1 and 2 asterisk explanation: G0365. Code G0365 was deleted from the Coding Guidelines and 93985 and 93986 were added.

10/01/2019 R6

Article revised and published on 10/17/2019 for dates of service on and after 10/01/2019 to reflect the annual ICD-10 code updates. The following ICD-10 codes have been added to the Group 1 codes: I26.93, I26.94, I80.241, I80.242, I80.243, I80.251, I80.252, I80.253, I82.451, I82.452, I82.453, I82.461, I82.462, I82.463, I82.551, I82.552, I82.553, I82.561, I82.562, I82.563. Minor formatting changes have been made in the Article text. Asterisks have been placed within the ICD-10 code tables with the Asterisk explanation notes added to the bottom of the tables. Due to system changes, the order of the Coding Section has been revised and new sections for CPT/HCPCS Modifiers and Other Coding Information have been added.

03/21/2019 R5

Article revised and published on 03/21/2019. All codes from L35451, Non-Invasive Peripheral Venous Studies, have been placed in this article per CMS Change Request 10901. Reference updated to National Correct Coding Initiative (NCCI).

01/01/2017 R4 Article revised and published on 01/12/2017 effective for dates of service on and after 01/01/2017 to reflect the annual CPT/HCPCS code updates. The following CPT/HCPCS code(s) have been deleted and therefore removed from the Article: 93965. Added notation that it would be inappropriate to report a NOC code for the deleted code 93965.
12/01/2016 R3 Article revised and published on 12/01/2016 to update the coding guidelines section consistent with LCD L35451 Non-Invasive Peripheral Venous Studies and to add the hyperlink to LCD L35451 to the Related Local Coverage Document(s) section.
10/01/2015 R2 Article revised on 07/22/2014 to reflect the use of short descriptors with CPT/HCPCS codes.

Revision History #1 revised on 07/22/2014 to correct the following statement: "Article revised for the states of Pennsylvania, Maryland, Delaware, District of Columbia, and New Jersey to change the Reference to related LCDs from L34880 to L34714 and L34854 to L34711." The correct LCD numbers are L34880 to L35451 and L34854 to L35397.
10/01/2015 R1 10-01-2014 - New article for those providers in the states of Arkansas, Louisiana, Mississippi, Colorado, Texas, Oklahoma, and New Mexico. Article revised for the states of Pennsylvania, Maryland, Delaware, District of Columbia, and New Jersey to change the Reference to related LCDs from L34880 to L34714 and L34854 to L34711. Article published on 07-24-2014.

Associated Documents

Related Local Coverage Documents
LCDs
L35451 - Non-Invasive Peripheral Venous Studies
Related National Coverage Documents
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
05/07/2021 03/18/2021 - N/A Currently in Effect You are here
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

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