Local Coverage Article Billing and Coding

Billing and Coding: Non-invasive Extracranial Arterial Studies

A57670

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General Information

Article ID
A57670
Article Title
Billing and Coding: Non-invasive Extracranial Arterial Studies
Article Type
Billing and Coding
Original Effective Date
10/03/2018
Revision Effective Date
N/A
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2021 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

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

N/A

Article Guidance

Article Text

This First Coast Billing and Coding Article for Local Coverage Determination (LCD) L33695 Non-invasive Extracranial Arterial Studies provides billing and coding guidance for frequency limitations as well as diagnosis limitations that support diagnosis to procedure code automated denials. However, services performed for any given diagnosis must meet all of the indications and limitations stated in the LCD, the general requirements for medical necessity as stated in CMS payment policy manuals, any and all existing CMS national coverage determinations, and all Medicare payment rules.

Refer to the LCD for reasonable and necessary requirements and limitations.

The redetermination process may be utilized for consideration of services performed outside of the reasonable and necessary requirements in the LCD.

Coding Guidelines

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.

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.  A hard copy, or a soft copy convertible to a hard copy provides a permanent record of the study performed and must be of a quality that meets accepted radiologic/ultrasonographic standards.

5.  If the provider of the service 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. The physician/nonphysician practitioner must state the clinical indication/medical necessity for the study in his/her order for the test. Billing providers are encouraged to obtain additional information from referring providers and/or patients or medical records. Referring physicians are required to provide appropriate diagnostic information to the performing provider.

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.

Utilization Guidelines

In accordance with CMS Ruling 95-1 (V), utilization of these services should be consistent with locally acceptable standards of practice.

Compliance with the provisions in LCD L33695, Non-invasive Extracranial Arterial Studies may be monitored and addressed through post payment data analysis and subsequent medical review audits.

Coding Information

CPT/HCPCS Codes

Group 1

(2 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
93880 DUPLEX SCAN OF EXTRACRANIAL ARTERIES; COMPLETE BILATERAL STUDY
93882 DUPLEX SCAN OF EXTRACRANIAL ARTERIES; UNILATERAL OR LIMITED STUDY

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(178 Codes)
Group 1 Paragraph

The following ICD-10-CM codes support medical necessity and provide limited coverage for CPT codes: 93880 and 93882

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.

Group 1 Codes
CodeDescription
G45.0 Vertebro-basilar artery syndrome
G45.1 Carotid artery syndrome (hemispheric)
G45.2 Multiple and bilateral precerebral artery syndromes
G45.3 Amaurosis fugax
G45.8 Other transient cerebral ischemic attacks and related syndromes
G45.9 Transient cerebral ischemic attack, unspecified
G46.0 Middle cerebral artery syndrome
G46.1 Anterior cerebral artery syndrome
G46.2 Posterior cerebral artery syndrome
H34.00 Transient retinal artery occlusion, unspecified eye
H34.01 Transient retinal artery occlusion, right eye
H34.02 Transient retinal artery occlusion, left eye
H34.03 Transient retinal artery occlusion, bilateral
H34.10 Central retinal artery occlusion, unspecified eye
H34.11 Central retinal artery occlusion, right eye
H34.12 Central retinal artery occlusion, left eye
H34.13 Central retinal artery occlusion, bilateral
H34.211 Partial retinal artery occlusion, right eye
H34.212 Partial retinal artery occlusion, left eye
H34.213 Partial retinal artery occlusion, bilateral
H34.219 Partial retinal artery occlusion, unspecified eye
H34.231 Retinal artery branch occlusion, right eye
H34.232 Retinal artery branch occlusion, left eye
H34.233 Retinal artery branch occlusion, bilateral
H34.239 Retinal artery branch occlusion, unspecified eye
H34.9 Unspecified retinal vascular occlusion
H53.121 Transient visual loss, right eye
H53.122 Transient visual loss, left eye
H53.123 Transient visual loss, bilateral
H53.129 Transient visual loss, unspecified eye
H53.131 Sudden visual loss, right eye
H53.132 Sudden visual loss, left eye
H53.133 Sudden visual loss, bilateral
H53.139 Sudden visual loss, unspecified eye
I63.031 Cerebral infarction due to thrombosis of right carotid artery
I63.032 Cerebral infarction due to thrombosis of left carotid artery
I63.033 Cerebral infarction due to thrombosis of bilateral carotid arteries
I63.039 Cerebral infarction due to thrombosis of unspecified carotid artery
I63.131 Cerebral infarction due to embolism of right carotid artery
I63.132 Cerebral infarction due to embolism of left carotid artery
I63.133 Cerebral infarction due to embolism of bilateral carotid arteries
I63.139 Cerebral infarction due to embolism of unspecified carotid artery
I63.231 Cerebral infarction due to unspecified occlusion or stenosis of right carotid arteries
I63.232 Cerebral infarction due to unspecified occlusion or stenosis of left carotid arteries
I63.233 Cerebral infarction due to unspecified occlusion or stenosis of bilateral carotid arteries
I63.239 Cerebral infarction due to unspecified occlusion or stenosis of unspecified carotid artery
I63.30 Cerebral infarction due to thrombosis of unspecified cerebral artery
I63.311 Cerebral infarction due to thrombosis of right middle cerebral artery
I63.312 Cerebral infarction due to thrombosis of left middle cerebral artery
I63.313 Cerebral infarction due to thrombosis of bilateral middle cerebral arteries
I63.319 Cerebral infarction due to thrombosis of unspecified middle cerebral artery
I63.321 Cerebral infarction due to thrombosis of right anterior cerebral artery
I63.322 Cerebral infarction due to thrombosis of left anterior cerebral artery
I63.323 Cerebral infarction due to thrombosis of bilateral anterior cerebral arteries
I63.329 Cerebral infarction due to thrombosis of unspecified anterior cerebral artery
I63.331 Cerebral infarction due to thrombosis of right posterior cerebral artery
I63.332 Cerebral infarction due to thrombosis of left posterior cerebral artery
I63.333 Cerebral infarction due to thrombosis of bilateral posterior cerebral arteries
I63.339 Cerebral infarction due to thrombosis of unspecified posterior cerebral artery
I63.341 Cerebral infarction due to thrombosis of right cerebellar artery
I63.342 Cerebral infarction due to thrombosis of left cerebellar artery
I63.343 Cerebral infarction due to thrombosis of bilateral cerebellar arteries
I63.349 Cerebral infarction due to thrombosis of unspecified cerebellar artery
I63.39 Cerebral infarction due to thrombosis of other cerebral artery
I63.40 Cerebral infarction due to embolism of unspecified cerebral artery
I63.411 Cerebral infarction due to embolism of right middle cerebral artery
I63.412 Cerebral infarction due to embolism of left middle cerebral artery
I63.413 Cerebral infarction due to embolism of bilateral middle cerebral arteries
I63.419 Cerebral infarction due to embolism of unspecified middle cerebral artery
I63.421 Cerebral infarction due to embolism of right anterior cerebral artery
I63.422 Cerebral infarction due to embolism of left anterior cerebral artery
I63.423 Cerebral infarction due to embolism of bilateral anterior cerebral arteries
I63.429 Cerebral infarction due to embolism of unspecified anterior cerebral artery
I63.431 Cerebral infarction due to embolism of right posterior cerebral artery
I63.432 Cerebral infarction due to embolism of left posterior cerebral artery
I63.433 Cerebral infarction due to embolism of bilateral posterior cerebral arteries
I63.439 Cerebral infarction due to embolism of unspecified posterior cerebral artery
I63.441 Cerebral infarction due to embolism of right cerebellar artery
I63.442 Cerebral infarction due to embolism of left cerebellar artery
I63.443 Cerebral infarction due to embolism of bilateral cerebellar arteries
I63.449 Cerebral infarction due to embolism of unspecified cerebellar artery
I63.49 Cerebral infarction due to embolism of other cerebral artery
I63.50 Cerebral infarction due to unspecified occlusion or stenosis of unspecified cerebral artery
I63.511 Cerebral infarction due to unspecified occlusion or stenosis of right middle cerebral artery
I63.512 Cerebral infarction due to unspecified occlusion or stenosis of left middle cerebral artery
I63.513 Cerebral infarction due to unspecified occlusion or stenosis of bilateral middle cerebral arteries
I63.519 Cerebral infarction due to unspecified occlusion or stenosis of unspecified middle cerebral artery
I63.521 Cerebral infarction due to unspecified occlusion or stenosis of right anterior cerebral artery
I63.522 Cerebral infarction due to unspecified occlusion or stenosis of left anterior cerebral artery
I63.523 Cerebral infarction due to unspecified occlusion or stenosis of bilateral anterior cerebral arteries
I63.529 Cerebral infarction due to unspecified occlusion or stenosis of unspecified anterior cerebral artery
I63.531 Cerebral infarction due to unspecified occlusion or stenosis of right posterior cerebral artery
I63.532 Cerebral infarction due to unspecified occlusion or stenosis of left posterior cerebral artery
I63.533 Cerebral infarction due to unspecified occlusion or stenosis of bilateral posterior cerebral arteries
I63.539 Cerebral infarction due to unspecified occlusion or stenosis of unspecified posterior cerebral artery
I63.541 Cerebral infarction due to unspecified occlusion or stenosis of right cerebellar artery
I63.542 Cerebral infarction due to unspecified occlusion or stenosis of left cerebellar artery
I63.543 Cerebral infarction due to unspecified occlusion or stenosis of bilateral cerebellar arteries
I63.549 Cerebral infarction due to unspecified occlusion or stenosis of unspecified cerebellar artery
I63.59 Cerebral infarction due to unspecified occlusion or stenosis of other cerebral artery
I63.6 Cerebral infarction due to cerebral venous thrombosis, nonpyogenic
I63.81 Other cerebral infarction due to occlusion or stenosis of small artery
I63.89 Other cerebral infarction
I63.9 Cerebral infarction, unspecified
I65.21 Occlusion and stenosis of right carotid artery
I65.22 Occlusion and stenosis of left carotid artery
I65.23 Occlusion and stenosis of bilateral carotid arteries
I65.29 Occlusion and stenosis of unspecified carotid artery
I65.8 Occlusion and stenosis of other precerebral arteries
I66.01 Occlusion and stenosis of right middle cerebral artery
I66.02 Occlusion and stenosis of left middle cerebral artery
I66.03 Occlusion and stenosis of bilateral middle cerebral arteries
I66.09 Occlusion and stenosis of unspecified middle cerebral artery
I66.11 Occlusion and stenosis of right anterior cerebral artery
I66.12 Occlusion and stenosis of left anterior cerebral artery
I66.13 Occlusion and stenosis of bilateral anterior cerebral arteries
I66.19 Occlusion and stenosis of unspecified anterior cerebral artery
I66.21 Occlusion and stenosis of right posterior cerebral artery
I66.22 Occlusion and stenosis of left posterior cerebral artery
I66.23 Occlusion and stenosis of bilateral posterior cerebral arteries
I66.29 Occlusion and stenosis of unspecified posterior cerebral artery
I66.3 Occlusion and stenosis of cerebellar arteries
I66.8 Occlusion and stenosis of other cerebral arteries
I66.9 Occlusion and stenosis of unspecified cerebral artery
I67.841 Reversible cerebrovascular vasoconstriction syndrome
I67.848 Other cerebrovascular vasospasm and vasoconstriction
I67.89 Other cerebrovascular disease
I72.0 Aneurysm of carotid artery
I72.5 Aneurysm of other precerebral arteries
I72.6 Aneurysm of vertebral artery
I77.71 Dissection of carotid artery
I77.74 Dissection of vertebral artery
I77.75 Dissection of other precerebral arteries
M31.5 Giant cell arteritis with polymyalgia rheumatica
M31.6 Other giant cell arteritis
R09.89 Other specified symptoms and signs involving the circulatory and respiratory systems
R22.0* Localized swelling, mass and lump, head
R22.1* Localized swelling, mass and lump, neck
R55 Syncope and collapse
S15.001A Unspecified injury of right carotid artery, initial encounter
S15.001D Unspecified injury of right carotid artery, subsequent encounter
S15.001S Unspecified injury of right carotid artery, sequela
S15.002A Unspecified injury of left carotid artery, initial encounter
S15.002D Unspecified injury of left carotid artery, subsequent encounter
S15.002S Unspecified injury of left carotid artery, sequela
S15.009A Unspecified injury of unspecified carotid artery, initial encounter
S15.009D Unspecified injury of unspecified carotid artery, subsequent encounter
S15.009S Unspecified injury of unspecified carotid artery, sequela
S15.011A Minor laceration of right carotid artery, initial encounter
S15.011D Minor laceration of right carotid artery, subsequent encounter
S15.011S Minor laceration of right carotid artery, sequela
S15.012A Minor laceration of left carotid artery, initial encounter
S15.012D Minor laceration of left carotid artery, subsequent encounter
S15.012S Minor laceration of left carotid artery, sequela
S15.019A Minor laceration of unspecified carotid artery, initial encounter
S15.019D Minor laceration of unspecified carotid artery, subsequent encounter
S15.019S Minor laceration of unspecified carotid artery, sequela
S15.021A Major laceration of right carotid artery, initial encounter
S15.021D Major laceration of right carotid artery, subsequent encounter
S15.021S Major laceration of right carotid artery, sequela
S15.022A Major laceration of left carotid artery, initial encounter
S15.022D Major laceration of left carotid artery, subsequent encounter
S15.022S Major laceration of left carotid artery, sequela
S15.029A Major laceration of unspecified carotid artery, initial encounter
S15.029D Major laceration of unspecified carotid artery, subsequent encounter
S15.029S Major laceration of unspecified carotid artery, sequela
S15.091A Other specified injury of right carotid artery, initial encounter
S15.091D Other specified injury of right carotid artery, subsequent encounter
S15.091S Other specified injury of right carotid artery, sequela
S15.092A Other specified injury of left carotid artery, initial encounter
S15.092D Other specified injury of left carotid artery, subsequent encounter
S15.092S Other specified injury of left carotid artery, sequela
S15.099A Other specified injury of unspecified carotid artery, initial encounter
S15.099D Other specified injury of unspecified carotid artery, subsequent encounter
S15.099S Other specified injury of unspecified carotid artery, sequela
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

* Use ICD-10 codes R22.0 or R22.1 to report a pulsatile neck mass.

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 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
999x Not Applicable

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.

CodeDescription
99999 Not Applicable

Other Coding Information

N/A

Revision History Information

N/A

Associated Documents

Related Local Coverage Documents
LCDs
L33695 - Non-invasive Extracranial Arterial 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
11/21/2019 10/03/2018 - N/A Currently in Effect You are here

Keywords

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