Local Coverage Article Billing and Coding

Billing and Coding: Non-Invasive Abdominal / Visceral Vascular Studies

A57591

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Article ID
A57591
Article Title
Billing and Coding: Non-Invasive Abdominal / Visceral Vascular Studies
Article Type
Billing and Coding
Original Effective Date
11/01/2019
Revision Effective Date
10/28/2021
Revision Ending Date
N/A
Retirement Date
N/A
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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.

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CMS National Coverage Policy

Italicized font represents CMS national language/wording copied directly from CMS Manuals or CMS Transmittals. Contractors are prohibited from changing national NCD language/wording.

Title XVIII of the Social Security Act section 1833 (e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

Title XVIII of the Social Security Act section 1862 (a) (1) (A) allows coverage and payment of those items or services that are considered to be medically reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

Title XVIII of the Social Security Act section 1862 (a) (1) (D) excludes Medicare payment for any expenses incurred for items or services that are investigational or experimental.

Title XVIII of the Social Security Act section 1862 (a) (7) excludes routine physical examinations and services from Medicare coverage.

42 CFR, Section 410.32 Diagnosis x-ray tests, diagnostic laboratory tests, and other diagnostic indicates that diagnostic tests may only be ordered by the treating physician (or other treating practitioner acting within the scope of his or her license and Medicare requirements) who furnishes a consultation or treats a beneficiary for a specific medical problem and who uses the results in the management of the beneficiary’s specific medical problem. Tests not ordered by the physician or other qualified non-physician provider who is treating the patient are not reasonable and necessary (42 CFR 411.15(k) (1).

42 CFR, Section 410.32 (b) Diagnostic x-ray and other diagnostic tests. (1) Basic rule … all diagnostic x-ray and other diagnostic tests covered under section 1861(s)(3) of the Act and payable under the physician fee schedule must be furnished under the appropriate level of supervision by a physician as defined in section 1861® of the Act. Services furnished without the required level of supervision are not reasonable and necessary. (see 42 CFR 411.15(k)(1)).

CMS Pub 100-02 Medicare Benefit Policy Manual, Chapter 15 – Covered Medical and Other Health Services, Section 80 – Requirements for Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic Tests.

CMS Pub 100-03 Medicare National Coverage Determinations (NCD) Manual - Chapter 1 – Coverage Determinations
Part 4 Section 220.5 - Ultrasound Diagnostic Procedures

CMS Pub 100-04 Medicare Claims Processing Manual, Chapter 13 – Radiology Services and Other Diagnostic Procedures, Sections –
10.1 Billing Part B Radiology Services and Other Diagnostic Procedures and
20 – Payment Conditions for Radiology Services,
Chapter 16 – Laboratory Services, Section
40.2 – Payment Limit for Purchased Services.

CMS Pub 100-08, Medicare Program Integrity Manual, Chapter 13 – Local Coverage Determinations, Section 13.5.1 – Reasonable and Necessary Provisions in LCDs.

CMS Publication 100-09, Medicare Contractor Beneficiary and Provider Communications Manual, Chapter 5 - Correct Coding Initiative.

Article Guidance

Article Text

The billing and coding information in this article is dependent on the coverage indications, limitations and/or medical necessity described in the related LCD.

Documentation Requirements
Adequate documentation is essential for high-quality patient care and to demonstrate the reasonableness and medical necessity of the procedure(s). Documentation must support the criteria for coverage as described in the Coverage Indications, Limitations, and/or Medical Necessity section of this LCD. There should be a permanent record of the performed studies and interpretation. The documentation should include a description of the studies performed and any contrast media and/or radiopharmaceuticals used. Any known significant patient reaction or complications should be recorded. Comparison with prior relevant imaging studies needs to be addressed in the documentation along with both normal and abnormal findings. Variations from normal size should be documented along with measurements. The report should address or answer any specific clinical questions. If there are factors that prevent answering the clinical questions, this should be explained in the documentation. Retention of the ultrasound examination images should be consistent both with clinical need and with relevant legal and local health care facility requirements.

If the provider of the study is other than the ordering/referring physician/nonphysician practitioner, that provider must maintain a copy of the test results and interpretation, along with copies of the ordering/referring physician/nonphysician practitioner’s order for the studies. This order is required to provide adequate diagnostic information to the performing provider. The physician/nonphysician practitioner must state the clinical indication/medical necessity for the study in his/her order for the test. The provider is responsible for ensuring the medical necessity of procedures and maintaining the medical record, which must be available to Medicare upon request. Results of all testing must be shared with the referring physician. Non-invasive vascular studies are medically reasonable and medically necessary only if the outcomes will be utilized in the clinical management of the patient.

Utilization Guidelines
Each patient’s condition and response to treatment must medically warrant the number of services reported for payment. Medicare requires the medical necessity for each study reported to be clearly documented in the patient’s medical record.

Frequency of follow-up studies will be carefully monitored for medical necessity and it is the responsibility of the physician/provider to maintain documentation of medical necessity in the patient’s medical record.

Generally, it is expected that noninvasive abdominal/visceral vascular studies would not be performed more than once in a year, excluding inpatient hospital (21) and emergency room (23) places of services.

Only one preoperative scan is considered reasonable and necessary for bypass surgery. If a more current preoperative scan is indicated for a patient with multiple comorbidities having difficulty being stabilized for surgery or a change in condition, the medical record would need to support the medical necessity of the second scan.

The frequency of medically necessary follow-up noninvasive abdominal/visceral vascular studies post-angioplasty is dictated by the vascular distribution treated.

Preventive and/or screening services unless covered under Statute are not covered by Medicare.

Coding Information

CPT/HCPCS Codes

Group 1

(6 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
93975 DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF ABDOMINAL, PELVIC, SCROTAL CONTENTS AND/OR RETROPERITONEAL ORGANS; COMPLETE STUDY
93976 DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF ABDOMINAL, PELVIC, SCROTAL CONTENTS AND/OR RETROPERITONEAL ORGANS; LIMITED STUDY
93978 DUPLEX SCAN OF AORTA, INFERIOR VENA CAVA, ILIAC VASCULATURE, OR BYPASS GRAFTS; COMPLETE STUDY
93979 DUPLEX SCAN OF AORTA, INFERIOR VENA CAVA, ILIAC VASCULATURE, OR BYPASS GRAFTS; UNILATERAL OR LIMITED STUDY
93980 DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF PENILE VESSELS; COMPLETE STUDY
93981 DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF PENILE VESSELS; FOLLOW-UP OR LIMITED STUDY

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(270 Codes)
Group 1 Paragraph

Abdominal/visceral vascular studies of abdominal, retroperitoneal, and pelvic organs (93975, 93976)

For codes in the table below that requires a 7th character: letter A initial encounter, D subsequent encounter or S sequela may be used.

Group 1 Codes
CodeDescription
I10 Essential (primary) hypertension
I11.0 Hypertensive heart disease with heart failure
I11.9 Hypertensive heart disease without heart failure
I12.0 Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease
I12.9 Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
I13.0 Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
I13.10 Hypertensive heart and chronic kidney disease without heart failure, with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
I13.11 Hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease, or end stage renal disease
I13.2 Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease
I15.0 Renovascular hypertension
I15.1 Hypertension secondary to other renal disorders
I15.2 Hypertension secondary to endocrine disorders
I15.8 Other secondary hypertension
I70.1 Atherosclerosis of renal artery
I71.1 Thoracic aortic aneurysm, ruptured
I71.2 Thoracic aortic aneurysm, without rupture
I71.3 Abdominal aortic aneurysm, ruptured
I71.4 Abdominal aortic aneurysm, without rupture
I71.5 Thoracoabdominal aortic aneurysm, ruptured
I71.6 Thoracoabdominal aortic aneurysm, without rupture
I72.2 Aneurysm of renal artery
I72.8 Aneurysm of other specified arteries
I74.01 Saddle embolus of abdominal aorta
I74.09 Other arterial embolism and thrombosis of abdominal aorta
I74.10 Embolism and thrombosis of unspecified parts of aorta
I74.19 Embolism and thrombosis of other parts of aorta
I74.5 Embolism and thrombosis of iliac artery
I74.8 Embolism and thrombosis of other arteries
I75.81 Atheroembolism of kidney
I75.89 Atheroembolism of other site
I76 Septic arterial embolism
I77.2 Rupture of artery
I77.3 Arterial fibromuscular dysplasia
I77.4 Celiac artery compression syndrome
I77.73 Dissection of renal artery
I77.79 Dissection of other specified artery
I77.810 Thoracic aortic ectasia
I77.811 Abdominal aortic ectasia
I77.812 Thoracoabdominal aortic ectasia
I77.819 Aortic ectasia, unspecified site
I80.8 Phlebitis and thrombophlebitis of other sites
I81 Portal vein thrombosis
I82.0 Budd-Chiari syndrome
I82.1 Thrombophlebitis migrans
I82.210 Acute embolism and thrombosis of superior vena cava
I82.211 Chronic embolism and thrombosis of superior vena cava
I82.290 Acute embolism and thrombosis of other thoracic veins
I82.291 Chronic embolism and thrombosis of other thoracic veins
I82.3 Embolism and thrombosis of renal vein
I86.1 Scrotal varices
I86.2 Pelvic varices
I86.3 Vulval varices
I86.4 Gastric varices
I86.8 Varicose veins of other specified sites
K55.011 Focal (segmental) acute (reversible) ischemia of small intestine
K55.012 Diffuse acute (reversible) ischemia of small intestine
K55.019 Acute (reversible) ischemia of small intestine, extent unspecified
K55.021 Focal (segmental) acute infarction of small intestine
K55.022 Diffuse acute infarction of small intestine
K55.029 Acute infarction of small intestine, extent unspecified
K55.031 Focal (segmental) acute (reversible) ischemia of large intestine
K55.032 Diffuse acute (reversible) ischemia of large intestine
K55.039 Acute (reversible) ischemia of large intestine, extent unspecified
K55.041 Focal (segmental) acute infarction of large intestine
K55.042 Diffuse acute infarction of large intestine
K55.049 Acute infarction of large intestine, extent unspecified
K55.051 Focal (segmental) acute (reversible) ischemia of intestine, part unspecified
K55.052 Diffuse acute (reversible) ischemia of intestine, part unspecified
K55.059 Acute (reversible) ischemia of intestine, part and extent unspecified
K55.061 Focal (segmental) acute infarction of intestine, part unspecified
K55.062 Diffuse acute infarction of intestine, part unspecified
K55.069 Acute infarction of intestine, part and extent unspecified
K55.1 Chronic vascular disorders of intestine
K55.30 Necrotizing enterocolitis, unspecified
K55.31 Stage 1 necrotizing enterocolitis
K55.32 Stage 2 necrotizing enterocolitis
K55.33 Stage 3 necrotizing enterocolitis
K55.8 Other vascular disorders of intestine
K70.2 Alcoholic fibrosis and sclerosis of liver
K70.30 Alcoholic cirrhosis of liver without ascites
K70.31 Alcoholic cirrhosis of liver with ascites
K74.00 Hepatic fibrosis, unspecified
K74.01 Hepatic fibrosis, early fibrosis
K74.02 Hepatic fibrosis, advanced fibrosis
K74.60 Unspecified cirrhosis of liver
K74.69 Other cirrhosis of liver
K76.6 Portal hypertension
N17.0 Acute kidney failure with tubular necrosis
N17.1 Acute kidney failure with acute cortical necrosis
N17.2 Acute kidney failure with medullary necrosis
N17.8 Other acute kidney failure
N17.9 Acute kidney failure, unspecified
N18.1 Chronic kidney disease, stage 1
N18.2 Chronic kidney disease, stage 2 (mild)
N18.30 Chronic kidney disease, stage 3 unspecified
N18.31 Chronic kidney disease, stage 3a
N18.32 Chronic kidney disease, stage 3b
N18.4 Chronic kidney disease, stage 4 (severe)
N18.5 Chronic kidney disease, stage 5
N26.1 Atrophy of kidney (terminal)
N26.2 Page kidney
N26.9 Renal sclerosis, unspecified
N27.0 Small kidney, unilateral
N27.1 Small kidney, bilateral
N28.0 Ischemia and infarction of kidney
N29 Other disorders of kidney and ureter in diseases classified elsewhere
N43.0 Encysted hydrocele
N43.1 Infected hydrocele
N43.2 Other hydrocele
N43.3 Hydrocele, unspecified
N43.40 Spermatocele of epididymis, unspecified
N43.41 Spermatocele of epididymis, single
N43.42 Spermatocele of epididymis, multiple
N44.00 Torsion of testis, unspecified
N44.01 Extravaginal torsion of spermatic cord
N44.02 Intravaginal torsion of spermatic cord
N44.03 Torsion of appendix testis
N44.04 Torsion of appendix epididymis
N44.1 Cyst of tunica albuginea testis
N44.2 Benign cyst of testis
N44.8 Other noninflammatory disorders of the testis
N45.1 Epididymitis
N45.2 Orchitis
N45.3 Epididymo-orchitis
N45.4 Abscess of epididymis or testis
N49.1 Inflammatory disorders of spermatic cord, tunica vaginalis and vas deferens
N49.2 Inflammatory disorders of scrotum
N49.3 Fournier gangrene
N49.8 Inflammatory disorders of other specified male genital organs
N49.9 Inflammatory disorder of unspecified male genital organ
N50.0 Atrophy of testis
N50.1 Vascular disorders of male genital organs
N50.3 Cyst of epididymis
N50.811 Right testicular pain
N50.812 Left testicular pain
N50.819 Testicular pain, unspecified
N50.82 Scrotal pain
N50.89 Other specified disorders of the male genital organs
N50.9 Disorder of male genital organs, unspecified
N51 Disorders of male genital organs in diseases classified elsewhere
N53.12 Painful ejaculation
N53.8 Other male sexual dysfunction
N53.9 Unspecified male sexual dysfunction
N83.511 Torsion of right ovary and ovarian pedicle
N83.512 Torsion of left ovary and ovarian pedicle
N83.521 Torsion of right fallopian tube
N83.522 Torsion of left fallopian tube
N83.53 Torsion of ovary, ovarian pedicle and fallopian tube
Q26.5 Anomalous portal venous connection
Q26.6 Portal vein-hepatic artery fistula
Q27.1 Congenital renal artery stenosis
Q27.2 Other congenital malformations of renal artery
Q27.33 Arteriovenous malformation of digestive system vessel
Q27.34 Arteriovenous malformation of renal vessel
Q60.0 Renal agenesis, unilateral
Q60.1 Renal agenesis, bilateral
Q60.3 Renal hypoplasia, unilateral
Q60.4 Renal hypoplasia, bilateral
Q60.6 Potter's syndrome
Q61.01 Congenital single renal cyst
Q61.02 Congenital multiple renal cysts
Q61.11 Cystic dilatation of collecting ducts
Q61.19 Other polycystic kidney, infantile type
Q61.2 Polycystic kidney, adult type
Q61.4 Renal dysplasia
Q61.5 Medullary cystic kidney
Q61.8 Other cystic kidney diseases
R09.89* Other specified symptoms and signs involving the circulatory and respiratory systems
R10.0 Acute abdomen
R10.11 Right upper quadrant pain
R10.12 Left upper quadrant pain
R10.13 Epigastric pain
R10.2 Pelvic and perineal pain
R10.31 Right lower quadrant pain
R10.32 Left lower quadrant pain
R10.33 Periumbilical pain
R10.84 Generalized abdominal pain
R18.0 Malignant ascites
R18.8 Other ascites
R19.00 Intra-abdominal and pelvic swelling, mass and lump, unspecified site
R19.01 Right upper quadrant abdominal swelling, mass and lump
R19.02 Left upper quadrant abdominal swelling, mass and lump
R19.03 Right lower quadrant abdominal swelling, mass and lump
R19.04 Left lower quadrant abdominal swelling, mass and lump
R19.05 Periumbilic swelling, mass or lump
R19.06 Epigastric swelling, mass or lump
R19.07 Generalized intra-abdominal and pelvic swelling, mass and lump
R19.09 Other intra-abdominal and pelvic swelling, mass and lump
R19.31 Right upper quadrant abdominal rigidity
R19.32 Left upper quadrant abdominal rigidity
R19.33 Right lower quadrant abdominal rigidity
R19.34 Left lower quadrant abdominal rigidity
R19.35 Periumbilic abdominal rigidity
R19.36 Epigastric abdominal rigidity
R19.37 Generalized abdominal rigidity
R94.4 Abnormal results of kidney function studies
R94.5 Abnormal results of liver function studies
S35.11XA Minor laceration of inferior vena cava, initial encounter
S35.12XA Major laceration of inferior vena cava, initial encounter
S35.19XA Other injury of inferior vena cava, initial encounter
S35.211A Minor laceration of celiac artery, initial encounter
S35.212A Major laceration of celiac artery, initial encounter
S35.218A Other injury of celiac artery, initial encounter
S35.221A Minor laceration of superior mesenteric artery, initial encounter
S35.222A Major laceration of superior mesenteric artery, initial encounter
S35.228A Other injury of superior mesenteric artery, initial encounter
S35.291A Minor laceration of branches of celiac and mesenteric artery, initial encounter
S35.292A Major laceration of branches of celiac and mesenteric artery, initial encounter
S35.298A Other injury of branches of celiac and mesenteric artery, initial encounter
S35.311A Laceration of portal vein, initial encounter
S35.318A Other specified injury of portal vein, initial encounter
S35.321A Laceration of splenic vein, initial encounter
S35.328A Other specified injury of splenic vein, initial encounter
S35.331A Laceration of superior mesenteric vein, initial encounter
S35.338A Other specified injury of superior mesenteric vein, initial encounter
S35.341A Laceration of inferior mesenteric vein, initial encounter
S35.348A Other specified injury of inferior mesenteric vein, initial encounter
S35.411A Laceration of right renal artery, initial encounter
S35.412A Laceration of left renal artery, initial encounter
S35.413A Laceration of unspecified renal artery, initial encounter
S35.414A Laceration of right renal vein, initial encounter
S35.415A Laceration of left renal vein, initial encounter
S35.416A Laceration of unspecified renal vein, initial encounter
S35.491A Other specified injury of right renal artery, initial encounter
S35.492A Other specified injury of left renal artery, initial encounter
S35.493A Other specified injury of unspecified renal artery, initial encounter
S35.494A Other specified injury of right renal vein, initial encounter
S35.495A Other specified injury of left renal vein, initial encounter
S35.496A Other specified injury of unspecified renal vein, initial encounter
S35.511A Injury of right iliac artery, initial encounter
S35.512A Injury of left iliac artery, initial encounter
S35.514A Injury of right iliac vein, initial encounter
S35.515A Injury of left iliac vein, initial encounter
S35.531A Injury of right uterine artery, initial encounter
S35.532A Injury of left uterine artery, initial encounter
S35.534A Injury of right uterine vein, initial encounter
S35.535A Injury of left uterine vein, initial encounter
S35.8X1A Laceration of other blood vessels at abdomen, lower back and pelvis level, initial encounter
S35.8X8A Other specified injury of other blood vessels at abdomen, lower back and pelvis level, initial encounter
T81.710A Complication of mesenteric artery following a procedure, not elsewhere classified, initial encounter
T81.711A Complication of renal artery following a procedure, not elsewhere classified, initial encounter
T82.817A Embolism due to cardiac prosthetic devices, implants and grafts, initial encounter
T82.818A Embolism due to vascular prosthetic devices, implants and grafts, initial encounter
T82.827A Fibrosis due to cardiac prosthetic devices, implants and grafts, initial encounter
T82.828A Fibrosis due to vascular prosthetic devices, implants and grafts, initial encounter
T82.837A Hemorrhage due to cardiac prosthetic devices, implants and grafts, initial encounter
T82.838A Hemorrhage due to vascular prosthetic devices, implants and grafts, initial encounter
T82.847A Pain due to cardiac prosthetic devices, implants and grafts, initial encounter
T82.848A Pain due to vascular prosthetic devices, implants and grafts, initial encounter
T82.857A Stenosis of other cardiac prosthetic devices, implants and grafts, initial encounter
T82.858A Stenosis of other vascular prosthetic devices, implants and grafts, initial encounter
T82.867A Thrombosis due to cardiac prosthetic devices, implants and grafts, initial encounter
T82.868A Thrombosis due to vascular prosthetic devices, implants and grafts, initial encounter
T82.897A Other specified complication of cardiac prosthetic devices, implants and grafts, initial encounter
T82.898A Other specified complication of vascular prosthetic devices, implants and grafts, initial encounter
T86.11 Kidney transplant rejection
T86.12 Kidney transplant failure
T86.13 Kidney transplant infection
T86.19 Other complication of kidney transplant
T86.41 Liver transplant rejection
T86.42 Liver transplant failure
T86.43 Liver transplant infection
T86.49 Other complications of liver transplant
T86.850 Intestine transplant rejection
T86.851 Intestine transplant failure
T86.852 Intestine transplant infection
T86.858 Other complications of intestine transplant
Z48.03 Encounter for change or removal of drains
Z48.812 Encounter for surgical aftercare following surgery on the circulatory system
Z48.89 Encounter for other specified surgical aftercare
Group 1 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Use this diagnostic code to report abdominal bruit.

Group 2

(223 Codes)
Group 2 Paragraph

Visceral vascular studies of aorta, inferior vena cava, iliac vasculature, and bypass grafts (93978, 93979)

For codes in the table below that require a 7th character: letter A initial encounter, D subsequent encounter or S sequela may be used.

Group 2 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
I27.82 Chronic pulmonary embolism
I70.0 Atherosclerosis of aorta
I70.211 Atherosclerosis of native arteries of extremities with intermittent claudication, right leg
I70.212 Atherosclerosis of native arteries of extremities with intermittent claudication, left leg
I70.213 Atherosclerosis of native arteries of extremities with intermittent claudication, bilateral legs
I70.218 Atherosclerosis of native arteries of extremities with intermittent claudication, other extremity
I70.221 Atherosclerosis of native arteries of extremities with rest pain, right leg
I70.222 Atherosclerosis of native arteries of extremities with rest pain, left leg
I70.223 Atherosclerosis of native arteries of extremities with rest pain, bilateral legs
I70.228 Atherosclerosis of native arteries of extremities with rest pain, other extremity
I70.231 Atherosclerosis of native arteries of right leg with ulceration of thigh
I70.232 Atherosclerosis of native arteries of right leg with ulceration of calf
I70.233 Atherosclerosis of native arteries of right leg with ulceration of ankle
I70.234 Atherosclerosis of native arteries of right leg with ulceration of heel and midfoot
I70.235 Atherosclerosis of native arteries of right leg with ulceration of other part of foot
I70.238 Atherosclerosis of native arteries of right leg with ulceration of other part of lower leg
I70.241 Atherosclerosis of native arteries of left leg with ulceration of thigh
I70.242 Atherosclerosis of native arteries of left leg with ulceration of calf
I70.243 Atherosclerosis of native arteries of left leg with ulceration of ankle
I70.244 Atherosclerosis of native arteries of left leg with ulceration of heel and midfoot
I70.245 Atherosclerosis of native arteries of left leg with ulceration of other part of foot
I70.248 Atherosclerosis of native arteries of left leg with ulceration of other part of lower leg
I70.25 Atherosclerosis of native arteries of other extremities with ulceration
I70.261 Atherosclerosis of native arteries of extremities with gangrene, right leg
I70.262 Atherosclerosis of native arteries of extremities with gangrene, left leg
I70.263 Atherosclerosis of native arteries of extremities with gangrene, bilateral legs
I70.268 Atherosclerosis of native arteries of extremities with gangrene, other extremity
I71.01 Dissection of thoracic aorta
I71.02 Dissection of abdominal aorta
I71.03 Dissection of thoracoabdominal aorta
I71.1 Thoracic aortic aneurysm, ruptured
I71.2 Thoracic aortic aneurysm, without rupture
I71.3 Abdominal aortic aneurysm, ruptured
I71.4 Abdominal aortic aneurysm, without rupture
I71.5 Thoracoabdominal aortic aneurysm, ruptured
I71.6 Thoracoabdominal aortic aneurysm, without rupture
I72.3 Aneurysm of iliac artery
I73.00 Raynaud's syndrome without gangrene
I73.1 Thromboangiitis obliterans [Buerger's disease]
I74.01 Saddle embolus of abdominal aorta
I74.09 Other arterial embolism and thrombosis of abdominal aorta
I74.11 Embolism and thrombosis of thoracic aorta
I74.19 Embolism and thrombosis of other parts of aorta
I74.5 Embolism and thrombosis of iliac artery
I75.021 Atheroembolism of right lower extremity
I75.022 Atheroembolism of left lower extremity
I75.023 Atheroembolism of bilateral lower extremities
I77.0 Arteriovenous fistula, acquired
I77.72 Dissection of iliac artery
I77.79 Dissection of other specified artery
I77.810 Thoracic aortic ectasia
I77.811 Abdominal aortic ectasia
I77.812 Thoracoabdominal aortic ectasia
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
I82.0 Budd-Chiari syndrome
I82.220 Acute embolism and thrombosis of inferior vena cava
I82.221 Chronic embolism and thrombosis of inferior vena cava
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
I82.521 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
I97.51 Accidental puncture and laceration of a circulatory system organ or structure during a circulatory system procedure
I97.52 Accidental puncture and laceration of a circulatory system organ or structure during other procedure
J95.71 Accidental puncture and laceration of a respiratory system organ or structure during a respiratory system procedure
J95.72 Accidental puncture and laceration of a respiratory system organ or structure during other procedure
K55.011 Focal (segmental) acute (reversible) ischemia of small intestine
K55.012 Diffuse acute (reversible) ischemia of small intestine
K55.019 Acute (reversible) ischemia of small intestine, extent unspecified
K55.021 Focal (segmental) acute infarction of small intestine
K55.022 Diffuse acute infarction of small intestine
K55.029 Acute infarction of small intestine, extent unspecified
K55.031 Focal (segmental) acute (reversible) ischemia of large intestine
K55.032 Diffuse acute (reversible) ischemia of large intestine
K55.039 Acute (reversible) ischemia of large intestine, extent unspecified
K55.041 Focal (segmental) acute infarction of large intestine
K55.042 Diffuse acute infarction of large intestine
K55.049 Acute infarction of large intestine, extent unspecified
K55.1 Chronic vascular disorders of intestine
K91.71 Accidental puncture and laceration of a digestive system organ or structure during a digestive system procedure
K91.72 Accidental puncture and laceration of a digestive system organ or structure during other procedure
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)
Q25.21 Interruption of aortic arch
Q25.29 Other atresia of aorta
Q25.3 Supravalvular aortic stenosis
Q25.40 Congenital malformation of aorta unspecified
Q25.41 Absence and aplasia of aorta
Q25.42 Hypoplasia of aorta
Q25.43 Congenital aneurysm of aorta
Q25.44 Congenital dilation of aorta
Q25.45 Double aortic arch
Q25.46 Tortuous aortic arch
Q25.47 Right aortic arch
Q25.48 Anomalous origin of subclavian artery
Q25.49 Other congenital malformations of aorta
Q25.8 Other congenital malformations of other great arteries
Q25.9 Congenital malformation of great arteries, unspecified
Q26.0 Congenital stenosis of vena cava
Q26.1 Persistent left superior vena cava
Q26.2 Total anomalous pulmonary venous connection
Q26.3 Partial anomalous pulmonary venous connection
Q26.8 Other congenital malformations of great veins
R09.89 Other specified symptoms and signs involving the circulatory and respiratory systems
R19.00 Intra-abdominal and pelvic swelling, mass and lump, unspecified site
R19.01 Right upper quadrant abdominal swelling, mass and lump
R19.02 Left upper quadrant abdominal swelling, mass and lump
R19.03 Right lower quadrant abdominal swelling, mass and lump
R19.04 Left lower quadrant abdominal swelling, mass and lump
R19.05 Periumbilic swelling, mass or lump
R19.06 Epigastric swelling, mass or lump
R19.07 Generalized intra-abdominal and pelvic swelling, mass and lump
R19.09 Other intra-abdominal and pelvic swelling, mass and lump
S35.01XA Minor laceration of abdominal aorta, initial encounter
S35.02XA Major laceration of abdominal aorta, initial encounter
S35.09XA Other injury of abdominal aorta, initial encounter
S35.11XA Minor laceration of inferior vena cava, initial encounter
S35.12XA Major laceration of inferior vena cava, initial encounter
S35.19XA Other injury of inferior vena cava, initial encounter
S35.511A Injury of right iliac artery, initial encounter
S35.512A Injury of left iliac artery, initial encounter
S35.514A Injury of right iliac vein, initial encounter
S35.515A Injury of left iliac vein, initial encounter
S35.534A Injury of right uterine vein, initial encounter
S35.535A Injury of left uterine vein, initial encounter
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
T82.530A 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
T82.817A Embolism due to cardiac prosthetic devices, implants and grafts, initial encounter
T82.818A Embolism due to vascular prosthetic devices, implants and grafts, initial encounter
T82.827A Fibrosis due to cardiac prosthetic devices, implants and grafts, initial encounter
T82.828A Fibrosis due to vascular prosthetic devices, implants and grafts, initial encounter
T82.837A Hemorrhage due to cardiac prosthetic devices, implants and grafts, initial encounter
T82.838A Hemorrhage due to vascular prosthetic devices, implants and grafts, initial encounter
T82.847A Pain due to cardiac prosthetic devices, implants and grafts, initial encounter
T82.848A Pain due to vascular prosthetic devices, implants and grafts, initial encounter
T82.857A Stenosis of other cardiac prosthetic devices, implants and grafts, initial encounter
T82.858A Stenosis of other vascular prosthetic devices, implants and grafts, initial encounter
T82.867A Thrombosis due to cardiac prosthetic devices, implants and grafts, initial encounter
T82.868A Thrombosis due to vascular prosthetic devices, implants and grafts, initial encounter
T82.897A Other specified complication of cardiac prosthetic devices, implants and grafts, initial encounter
T82.898A Other specified complication of vascular prosthetic devices, implants and grafts, initial encounter
T86.11 Kidney transplant rejection
T86.12 Kidney transplant failure
T86.13 Kidney transplant infection
T86.19 Other complication of kidney transplant
T86.41 Liver transplant rejection
T86.42 Liver transplant failure
T86.43 Liver transplant infection
T86.49 Other complications of liver transplant
Z48.812 Encounter for surgical aftercare following surgery on the circulatory system
Z95.820 Peripheral vascular angioplasty status with implants and grafts
Z95.828 Presence of other vascular implants and grafts

Group 3

(53 Codes)
Group 3 Paragraph

Penile vascular studies (93980, 93981)

For codes in the table below that require a 7th character: letter A initial encounter, D subsequent encounter or S sequela may be used.

Group 3 Codes
CodeDescription
N48.31 Priapism due to trauma
N48.81 Thrombosis of superficial vein of penis
N48.82 Acquired torsion of penis
N48.83 Acquired buried penis
N48.89 Other specified disorders of penis
N50.1 Vascular disorders of male genital organs
S38.001A Crushing injury of unspecified external genital organs, male, initial encounter
S38.01XA Crushing injury of penis, initial encounter
S38.02XA Crushing injury of scrotum and testis, initial encounter
T83.010A Breakdown (mechanical) of cystostomy catheter, initial encounter
T83.011A Breakdown (mechanical) of indwelling urethral catheter, initial encounter
T83.012A Breakdown (mechanical) of nephrostomy catheter, initial encounter
T83.018A Breakdown (mechanical) of other urinary catheter, initial encounter
T83.020A Displacement of cystostomy catheter, initial encounter
T83.021A Displacement of indwelling urethral catheter, initial encounter
T83.022A Displacement of nephrostomy catheter, initial encounter
T83.028A Displacement of other urinary catheter, initial encounter
T83.090A Other mechanical complication of cystostomy catheter, initial encounter
T83.091A Other mechanical complication of indwelling urethral catheter, initial encounter
T83.092A Other mechanical complication of nephrostomy catheter, initial encounter
T83.098A Other mechanical complication of other urinary catheter, initial encounter
T83.110A Breakdown (mechanical) of urinary electronic stimulator device, initial encounter
T83.111A Breakdown (mechanical) of implanted urinary sphincter, initial encounter
T83.112A Breakdown (mechanical) of indwelling ureteral stent, initial encounter
T83.113A Breakdown (mechanical) of other urinary stents, initial encounter
T83.118A Breakdown (mechanical) of other urinary devices and implants, initial encounter
T83.120A Displacement of urinary electronic stimulator device, initial encounter
T83.121A Displacement of implanted urinary sphincter, initial encounter
T83.122A Displacement of indwelling ureteral stent, initial encounter
T83.123A Displacement of other urinary stents, initial encounter
T83.128A Displacement of other urinary devices and implants, initial encounter
T83.190A Other mechanical complication of urinary electronic stimulator device, initial encounter
T83.191A Other mechanical complication of implanted urinary sphincter, initial encounter
T83.192A Other mechanical complication of indwelling ureteral stent, initial encounter
T83.193A Other mechanical complication of other urinary stent, initial encounter
T83.198A Other mechanical complication of other urinary devices and implants, initial encounter
T83.21XA Breakdown (mechanical) of graft of urinary organ, initial encounter
T83.22XA Displacement of graft of urinary organ, initial encounter
T83.23XA Leakage of graft of urinary organ, initial encounter
T83.24XA Erosion of graft of urinary organ, initial encounter
T83.25XA Exposure of graft of urinary organ, initial encounter
T83.29XA Other mechanical complication of graft of urinary organ, initial encounter
T83.410A Breakdown (mechanical) of implanted penile prosthesis, initial encounter
T83.411A Breakdown (mechanical) of implanted testicular prosthesis, initial encounter
T83.418A Breakdown (mechanical) of other prosthetic devices, implants and grafts of genital tract, initial encounter
T83.420A Displacement of implanted penile prosthesis, initial encounter
T83.421A Displacement of implanted testicular prosthesis, initial encounter
T83.428A Displacement of other prosthetic devices, implants and grafts of genital tract, initial encounter
T83.490A Other mechanical complication of implanted penile prosthesis, initial encounter
T83.491A Other mechanical complication of implanted testicular prosthesis, initial encounter
T83.498A Other mechanical complication of other prosthetic devices, implants and grafts of genital tract, initial encounter
T83.718A Erosion of other implanted mesh to organ or tissue, initial encounter
T83.728A Exposure of other implanted mesh into organ or tissue, initial encounter

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

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

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.

N/A

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.

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Other Coding Information

N/A

Revision History Information

Revision History DateRevision History NumberRevision History Explanation
10/28/2021 R2

10/28/2021 Review completed 09/30/2021.

10/01/2020 R1

10/01/2020 ICD-10-CM code updates to Group 1: added K74.00, K74.01, K74.02, N18.30, N18.31, N18.32 and deleted: K74.0, N18.3. Review completed 09/09/2020.

Associated Documents

Related National Coverage Documents
NCDs
220.5 - Ultrasound Diagnostic Procedures
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
10/19/2021 10/28/2021 - N/A Currently in Effect You are here
09/21/2020 10/01/2020 - 10/27/2021 Superseded View
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Keywords

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