DRAFT LCD Reference Article Billing and Coding Article

Billing and Coding: Peripheral Venous Ultrasound

DA57125

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Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

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Source Article ID
A57125
Draft Article ID
DA57125
Original ICD-9 Article ID
Not Applicable
Draft Article Title
Billing and Coding: Peripheral Venous Ultrasound
Article Type
Billing and Coding
Original Effective Date
N/A
Revision Effective Date
N/A
Revision Ending Date
N/A
Retirement Date
ANTICIPATED 11/15/2024
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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

Internet Only Manuals (IOMs):

  • CMS IOM Publication 100-04, Medicare Claims Processing Manual,
    • Chapter 4, Section 20.6.2 Use of Modifiers -50, -LT and -RT
    • Chapter 12, Section 40.7.B Billing Instructions for Bilateral Surgeries

Social Security Act (Title XVIII) Standard References:

  • 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.

Medicare National Correct Coding Initiative (NCCI) Policy Manual:

  • Chapter XI Medicine Evaluation and Management Services

Code of Federal Regulations (CFR) References:

  • CFR, Title 42, Volume 2, Chapter IV, Part 410.32(a) Ordering diagnostic tests

Article Guidance

Article Text

This Billing and Coding Article provides billing and coding guidance for Proposed Local Coverage Determination (LCD) DL33693 Peripheral Venous Ultrasound. 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.

Note: Multiple duplex scans plus noninvasive physiologic studies of the upper and lower extremities (93970, 93971, 93922 and 93923) and 93924-93931 cannot be billed on the same day.

The use of a simple hand-held or other Doppler device that does not produce hard copy data or that produces a record that does not permit analysis of bidirectional vascular flow, is considered to be part of the physical examination of the vascular system and is not separately reported.

CPT code 93971

Consistent with the LCD, doppler ultrasound scanning is the current standard for the preoperative evaluation of reflux in patients with chronic venous insufficiency.

Correct coding guidelines indicate that CPT code 93971 should be used to report either a limited bilateral or a complete unilateral study. It would not be appropriate to report -50 modifier with CPT code 93971 for a limited bilateral study.

Documentation Requirements

  1. All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
  2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
  3. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.
  4. Images of all relevant areas, both normal and abnormal, should be recorded and stored in a retrievable format (electronic preferred).
  5. A signed final report of the ultrasound findings and impression should be included in the patient’s medical record and is the definitive documentation of the study. The final report should include but is not limited to the following demographic components:
    • A description of examination findings, using appropriate anatomic and ultrasound terminology. (Use of acronyms and abbreviations should be avoided)
    • The concluding statements or summary of the report should include these components:
      • An impression, conclusion, or summary statement
      • A specific diagnosis or differential diagnosis, if appropriate
      • A recommendation for follow-up studies, if clinically applicable
      • An accounting of any failure to include standard views or other necessary components (as listed in the appropriate practice parameter)
      • If prior relevant imaging studies were reviewed, a statement of comparison should be included
      • Details concerning any provider-to-provider communication in cases in which a delay in communication may have an adverse effect on the patient’s outcome.
  6. An order from the treating physician/nonphysician practitioner as required by CFR, Title 42, Volume 2, Chapter IV, Part 410.32(a) Ordering diagnostic tests.
  7. The medical record for patients with known venous thrombosis on therapy should reflect what clinical change occurred and how the change in thrombus burden will alter treatment.

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description
999x Not Applicable
N/A

Revenue Codes

Code Description
0921 Other Diagnostic Services - Peripheral Vascular Lab
N/A

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
Code Description
93970 Extremity study
93971 Extremity study
N/A

CPT/HCPCS Modifiers

Group 1

(1 Code)
Group 1 Paragraph

N/A

Group 1 Codes
Code Description
50 BILATERAL PROCEDURE: UNLESS OTHERWISE IDENTIFIED IN THE LISTINGS, BILATERAL PROCEDURES THAT ARE PERFORMED AT THE SAME OPERATIVE SESSION SHOULD BE IDENTIFIED BY ADDING THE MODIFIER -50 TO THE APPROPRIATE FIVE DIGIT CODE OR BY USE OF THE SEPARATE FIVE DIGIT MODIFIER CODE 09950
N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(199 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
Code Description
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
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.B11 Acute embolism and thrombosis of right subclavian vein
I82.B12 Acute embolism and thrombosis of left subclavian vein
I82.B13 Acute embolism and thrombosis of subclavian vein, bilateral
I82.B21 Chronic embolism and thrombosis of right subclavian vein
I82.B22 Chronic embolism and thrombosis of left subclavian vein
I82.B23 Chronic embolism and thrombosis of subclavian 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
I87.011 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)
I87.311 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
I89.0 Lymphedema, not elsewhere classified
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
M79.651 Pain in right thigh
M79.652 Pain in left thigh
M79.661 Pain in right lower leg
M79.662 Pain in left lower leg
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
Q82.0 Hereditary lymphedema
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
T81.72XA Complication of vein following a procedure, not elsewhere classified, initial encounter
T81.72XD Complication of vein following a procedure, not elsewhere classified, subsequent encounter
Z01.810* Encounter for preprocedural cardiovascular 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: ICD-10-CM codes Z01.810 and Z09 are only covered for CPT code 93971.

*NOTE: Use ICD-10-CM code Z01.810 when reporting preoperative examination of potential harvest vein grafts to be used during bypass surgery.

*NOTE: Use ICD-10-CM code Z09 only to describe a venous duplex performed for post procedure assessment of a venous ablation procedure.

N/A

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

Group 1

(1 Code)
Group 1 Paragraph

All those not listed under the “ICD-10-CM Codes that Support Medical Necessity” section of this article.

Group 1 Codes
Code Description
XX000 Not Applicable
N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

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
999x Not Applicable
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.

Code Description
0921 Other Diagnostic Services - Peripheral Vascular Lab
N/A

Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

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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
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation
N/A

Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
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Keywords

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