CPT Code Details

Transcription

1 CPT Code Details Code Descriptor Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study Lay Term The provider performs a duplex ultrasound scan of the lower extremity arteries or bypass grafts on both sides. Providers perform noninvasive arterial diagnostic procedures to examine the rate of blood flow and to assess the presence of blockage in the lower extremity arteries. Modifier Explanation With the patient lying on an exam table, the provider applies a gel to the lower extremities to improve contact between the transducer and the skin and help the sound waves penetrate the skin better. The provider then presses the transducer firmly against the skin and sweeps it back and forth over the area to be examined. The test usually takes about 30 minutes. Tips For the same procedure performed on only one lower extremity, report This category of tests includes plethysmography, transcutaneous oxygen tension measurements (TCOM), and Doppler waveform analysis. No need to add modifier 50 for a bilateral study as that is already mentioned in the Code Descriptor. This procedure includes the use of a simple hand held device. CPT includes a range of codes for arterial Doppler studies on the extremities. Coding will vary depending on if the diagnostic test was a limited or complete study, if the study followed a treadmill stress test, and or if the study included the criteria for a Duplex scan. For some providers, coding may also depend on the diagnosis code. Check your provider's documentation and review the options in code family to 93931, Noninvasive extremity arterial studies, including digits, to ensure you choose correctly. When your provider performs spectral and color Doppler evaluation of the extremities, you should use one of the following appropriate codes: Code or 93926, Duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or limited study; Code 93930, Duplex scan of upper extremity arteries or arterial bypass grafts; complete bilateral study, or 93931, Duplex scan of upper extremity arteries or arterial bypass grafts; unilateral or limited study;

2 Or code 93970, Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study, or 93971, Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study, In conjunction with 76881,Ultrasound, complete joint (i.e., joint space and peri articular soft tissue structures) real time with image documentation or 76882,Ultrasound, limited, joint or other nonvascular extremity structure(s) (e.g., joint space, peri articular tendon[s], muscle[s], nerve[s], other soft tissue structure[s], or soft tissue mass[es]), real time with image documentation. Meanwhile, CPT 2011 revises and revalues codes for noninvasive physiologic studies of the upper or lower extremity arteries: Clinical Scenarios: Question: Does include the aorta and iliac arteries? If not and we want the aorta and iliac arteries, do we include 93978, Duplex scan of the aorta, IVC, and iliac vasculature? Answer: You should be able to report both codes, assuming you have supporting orders and documentation. Code 93925, Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study, describes an evaluation of the arteries from the groin downward. Code 93978, Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; complete study, describes an evaluation of the arteries from the diaphragm to the groin. These evaluations, which focus on different segments of the body, do not overlap, are complementary to each other and, in combination, provide the provider with the information necessary to develop a treatment plan for peripheral arterial disease of the legs. The medical literature indicates that the combination of the two services described by codes and 93978, in many cases, can be considered the standard of care for peripheral arterial disease of the legs. CPT Guidelines Section Specific Guideline Vascular studies include patient care required to perform the studies, supervision of the studies and interpretation of study results with copies for patient records of hard copy output with analysis of all data, including bidirectional vascular flow or imaging when provided. The use of a simple hand-held or other Doppler device that does not produce hard copy output, 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. The Ankle-Brachial Index (or ABI) is reportable with or as long as simultaneous Doppler recording and analysis of bidirectional blood flow, volume plethysmography, or transcutaneous oxygen tension measurements are also performed. Duplex scan (eg, 93880, 93882) describes an ultrasonic scanning procedure for characterizing the pattern and direction of blood flow in arteries or veins with the production of real-time images integrating B-mode two-dimensional vascular structure, Doppler spectral analysis, and color flow Doppler imaging. Physiologic studies Noninvasive physiologic studies are performed using equipment separate and distinct from the duplex ultrasound imager. Codes 93922, 93923, describe the evaluation of non-imaging physiologic recordings of pressures with Doppler analysis of bi-directional blood flow, plethysmography, and/or oxygen tension measurements appropriate for the anatomic area studied. Limited studies for lower extremity require either: (1) ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus bidirectional Doppler waveform recording and analysis at 1-2 levels; or (2) ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus volume plethysmography at 1-2 levels; or (3) ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries with transcutaneous oxygen tension measurements at 1-2 levels. Potential levels include high thigh, low thigh, calf, ankle, metatarsal and toes.

3 Limited studies for upper extremity require either: (1) Doppler-determined systolic pressures and bidirectional Doppler waveform recording and analysis at 1-2 levels; or (2) Doppler-determined systolic pressures and volume plethysmography at 1-2 levels; or (3) Doppler-determined systolic pressures and transcutaneous oxygen tension measurements at 1-2 levels. Potential levels include arm, forearm, wrist, and digits. Complete studies for lower extremity require either: (1) ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus bidirectional Doppler waveform recording and analysis at 3 or more levels; or (2) ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus volume plethysmography at 3 or more levels; or (3) ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries with transcutaneous oxygen tension measurements at 3 or more levels. Alternatively, a complete study may be reported with measurements at a single level if provocative functional maneuvers (eg, measurements with postural provocative tests, or measurements with reactive hyperemia) are performed. Complete studies for upper extremity require either: (1) Doppler-determined systolic pressures and bidirectional Doppler waveform recording and analysis at 3 or more levels; or (2) Doppler-determined systolic pressures and volume plethysmography at 3 or more levels; or (3) Dopplerdetermined systolic pressures and transcutaneous oxygen tension measurements at 3 or more levels. Potential levels include arm, forearm, wrist, and digits. Alternatively, a complete study may be reported with measurements at a single level if provocative functional maneuvers (eg, measurements with postural provocative tests, or measurements with cold stress) are performed. ICD-9 Vol 1 Crossref 440.0, , , , , , , , 440.4, 442.2, 442.3, 443.1, , , 447.0, 449, , 903.1, 903.2, 903.3, 903.5, 903.8, 903.9, 904.0, , , , , 904.7, 904.8, Fee Schedule Medicare Fees Facility Non Facility RVU - Nonfacility Work RVU: PE RVU: Malpractice RVU: Total RVU:

4 RVU - Facility Work RVU: PE RVU: Malpractice RVU: Total RVU: Global & Other Info Global Split Preoperative %: 0 Intraoperative %: 0 Postoperative %: 0 Total RVU: 0 Global Period (days): XXX Radiology Diagnostic Tests : 99 Code Status : A PC/TC Indicator : 1 Endoscopic Base Code : None Medically Unlikely Edit (MUE) : None Modifier Guidelines MULT PROC 51 Modifier Rules(Click on rules for Details) TC diagnostic cardiovascular services reduction applies BILAT SURG 50 No 150% bilateral payment boost ASST SURG 80 Assistant payment allowed when supported CO-SURG 62 Co-surgeons not permitted TEAM SURG 66 Team surgeons not permitted MINIMUM ASST SURG 81 Assistant payment allowed when supported. ASST SURG (QUALIFIED RESI. NA) 82 Assistant payment allowed when supported. PHYSICIAN SUPERVISION *PS Concept does not apply.

5 MUE Medically Unlikely Edits Source: 2017 Medically Unlikely Edits (MUE) Publisher: CMS Date: April 01, 2017 Services MUE MAI MUE Rationale Practitioner Services 1 3 Nature of Service/Procedure DME Suplier Services NA NA NA Facility Outpatient Services 1 3 Nature of Service/Procedure