Procedure code and Description
Group 1 Codes:
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
Coverage Indications, Limitations, and/or Medical Necessity
Non-invasive abdominal/visceral vascular studies utilize ultrasonic Doppler and physiologic principles to assess the irregularities in blood flow in renal, iliac, and femoral artery systems. These tests are also used to diagnose aortic aneurysms. Noninvasive abdominal/ visceral vascular studies include the patient care required to perform the studies, supervision of the studies, and interpretation of study results, with copies for patient records of test results and analysis of all data, including bi-directional vascular flow or imaging when provided.
Diagnostic tests must be ordered by the physician who is treating the beneficiary and who will use the results in the management of the beneficiary’s specific medical problem. Services are deemed medically necessary when all of the following conditions are met:
Signs/symptoms of ischemia or altered blood flow are present;
The information is necessary for appropriate medical and/or surgical management;
The test is not redundant of other diagnostic procedures that must be performed. Although, in some circumstances, non-invasive vascular tests are complimentary, such as MRA and duplex, where the latter may confirm an indeterminate finding or demonstrate the physiologic significance of an anatomic stenosis such as in renal, iliac, and/or femoral arteries.
Duplex Scans: Duplex combines Doppler and conventional ultrasound, allowing the structure of blood vessels, how the blood is flowing through the vessels, and whether there is any obstruction in the vessels to be seen. Color Doppler produces a picture of the blood vessel, and a computer converts the Doppler sounds into colors overlaid on the image, representing information about the speed and direction of blood flow. Using spectral Doppler analysis, the duplex scan images provide anatomic and hemodynamic information, identifying the presence of any stenosis or plaque in the arteries. Duplex scans are in real-time.
Abdominal/Visceral Vascular Studies
Abdominal/visceral non-invasive vascular studies are indicated in the evaluation and /or management of vascular disease along with, the narrowing or blockage of arteries that supply blood to the abdomen including intestines (mesenteric vascular disease), pelvic and scrotal contents, and/or retroperitoneal organs including the kidneys (renal vascular disease).
Abdominal, Retroperitoneal and Pelvic Organs (93975, 93976)
Stenosis of visceral artery (atherosclerotic, fibromuscular dysplasia, vasculitis, functional).
Aneurysm of visceral artery.
Portal hypertension, with or without ascites.
Cirrhosis of the liver.
Venous embolism, hemorrhage, infection, and/or thrombosis of visceral vein (renal, hepatic, mesenteric, portal or splenic).
Stenosis of visceral vein (renal, hepatic, mesenteric, portal or splenic).
Complications of internal (biological) (synthetic) prosthetic device implant and/or graft.
Complications in abdominal organ or tissue transplant.
Pain or swelling of scrotal contents which may be a result of suspected obstruction in arterial inflow or venous outflow to testicles or related structure.
Torsion of the spermatic cord; acute epididymitis or epididymoorchitis; or torsion of the testicular appendages.
Hypertension and normotensive renovascular disease with impaired renal function which could be acute kidney failure, chronic kidney disease, end stage renal disease, or other vascular disorders of the kidneys.
Pain or swelling of the female genital organs which may be the result of torsion of the ovaries, ovarian pedicle or fallopian tube.
Trauma to the abdominal, retroperitoneal and/or pelvic organs, arteries, and /or veins.
Aorta, Inferior vena cava, Iliac Vasculature and Bypass grafts (93978, 93979)
Atherosclerosis of aorta.
Atherosclerosis of the extremities with intermittent claudication.
Atherosclerosis of other specified arteries.
Aortic aneurysm and dissection.
Aneurysm of iliac artery.
Thromboangiitis obliterans (Buerger’s disease).
Peripheral vascular disease unspecified.
Arterial embolism and thrombosis of abdominal aorta.
Arterial embolism and thrombosis of iliac artery.
Phlebitis and thrombophlebitis of iliac vein.
Venous embolism and thrombosis of vena cava.
Complications related to surgical procedures involving prosthetic device implant, graft, and/or shunts.
Complications of organ or tissue transplant.
Trauma to the chest wall and /or abdomen resulting in a possible injury to the aorta, inferior vena cava and/or iliac vasculature.
Vascular studies are not the initial diagnostic modality for the evaluation of abdominal pain/tenderness. There must be a high index of suspicion that the pain is caused by a vascular disorder, such as mesentery ischemia.
Routine imaging of the iliac veins is not medically necessary. Exceptions will be made for specific medical indications of possible propagation of a known thrombus for consideration for placement of a vena cava filter device via the femoral approach. The medical necessity must be documented in the medical record.
Abdominal aortic aneurysms > four cm in diameter may be followed with abdominal ultrasound every six months. Documentation of medical necessity needs to be provided for studies performed more frequently.
The outcome must impact the clinical management of the patient. For example, if a patient is going to proceed on to other diagnostic and/or therapeutic procedures regardless of the outcome of the noninvasive studies, the non-invasive vascular studies are usually not medically necessary. That is, if it is obvious from the findings of the history and physical examination that the patient is going to proceed to angiography, then noninvasive vascular studies may not be medically necessary.
Duplex scanning in the evaluation of an abdominal aortic aneurysm is of limited value unless there is a pulsatile abdominal mass and signs and symptoms of peripheral vascular disease are present.
Noninvasive vascular studies are medically necessary only if the outcome will potentially impact the clinical course of the patient. For example, if a patient is going to proceed on to other diagnostic and/or therapeutic procedures regardless of the outcome of noninvasive studies, noninvasive vascular procedures are usually not medically necessary. That is, if it is obvious from the findings of the history and physical examination that the patient is going to proceed to angiography, then noninvasive vascular studies may not be medically necessary.
The accuracy of noninvasive vascular diagnostic studies depends on the knowledge, skills and experience of the technologist and interpreter. Consequently, the providers of interpretations must be capable of demonstrating documented training and experience and maintain documentation of such for possible audit. Further, noninvasive vascular diagnostic studies must be either (1) performed by persons with appropriate training that have demonstrated minimum entry level competency by being credentialed by a nationally recognized credentialing organization in vascular technology (e.g., American Registry of Radiologic Technologists (ARRT) in vascular technology), (2) performed by or under the direct supervision of a physician, or (3) performed in facilities with laboratories accredited in vascular technology.
Penile Vascular Studies (93980, 93981)
Duplex scans of the arterial inflow and venous outflow of penile vessels, have no therapeutic implications. Therefore, they are considered not medically reasonable or necessary, except in a patient with treatment failure who has sustained a documented groin injury where a vascular etiology for impotence is suspected.
Credentialing and Accreditation Standards
The accuracy of non-invasive vascular diagnostic studies depends on the knowledge, skill, and experience of the technologist and interpreter. Consequently, the physician performing and/or interpreting the study must be capable of demonstrating documented training and experience. A vascular diagnostic study may be personally performed by a physician, a certified technologist, or in a certified vascular testing lab.
Services will be considered medically reasonable and necessary only if performed by appropriately trained providers.
All non-invasive vascular diagnostic studies must be performed meeting at least one of the following:
performed by a licensed qualified physician, or
performed by a technician who is certified in vascular technology, or
performed in facilities with laboratories accredited in vascular technology.
A licensed qualified physician for these services is defined as:
Having trained and acquired expertise within the framework of an accredited residency or fellowship program in the applicable specialty/subspecialty in ultrasound (US) or must reflect equivalent education, training, and expertise endorsed by an academic institution in ultrasound or by applicable specialty/subspecialty society in ultrasound, or
Has the Registered Vascular Technologist (RVT), Registered Physician Vascular Interpretation (RPVI), or ASN: Neuroimaging Subspecialty Certification; and
Is able to provide evidence of proficiency in the performance and interpretation of each type of diagnostic procedure performed.
Nonphysician personnel performing tests must demonstrate basic qualifications to perform tests and have training and proficiency as evidenced by licensure or certification by an appropriate State health or education department. In the absence of a State licensing board, non-physician personnel must be certified by an appropriate national credentialing body.
Appropriate personnel certification includes the American Registry of Diagnostic Medical Sonographers (ARDMS), Registered Vascular Technologist (RVT) credential; or Cardiovascular Credentialing International’s Registered Vascular Specialist (RVS).
Laboratories accredited by the Intersocietal Accreditation Commission (IAC), American College of Radiology (ACR) Vascular Ultrasound Program, Joint Commission or DNV-GL must follow the accrediting body’s standards.
ICD-10 Codes that Support Medical Necessity
ICD-10 CODE DESCRIPTION
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
K74.0 Hepatic 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)
N18.3 Chronic kidney disease, stage 3 (moderate)
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
- Medical Billing Question and Answer - Terms
- Insurance Denial Claim Appeal Guidelines.
- Medical Billing Downloads
- Understand Medical Billing
- Medical Billing Outsource
- Medicare Coverage and Plan Overview
- Advertise with us
- EVALUATION AND MANAGEMENT CPT code [99201-99499] - Full List
- Overall Medical billing process
- CPT Code 99201, 99202, 99203, 99204, 99205 - Which code to USE
- Internal Medical Billing Audit - how to do
Medical Billing Popular Articles
Procedure code and Description 99251 Inpatient consultation for a new or established patient, which requires these 3 key components: A pro...
• G0502: Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of behavioral health care manager...
Hyperlipidemia Hyperlipidemia (hyperlipemia) involves abnormally elevated levels of any or all lipids and/or lipoproteins in the blood. Hy...
HCPCS Codes Effective for claims with dates of service on June 30, 2011, Medicare providers shall report one of the following HCPCS codes...
Generally speaking, when we say 'objective measures,' what does that mean? Answer: Objective measures consist of standardized p...
Q: My patient enrolled in a Medicare Advantage (MA) plan during the middle of the inpatient hospital stay. Who should I bill? A: When a p...
Its often confused that BCBS have lot of prefixes and where to contact. However we have some guide to follow, using prefixes we could find t...
Denial code co - 45 - Charges exceed your contracted/legislated fee arrangement. Note: This adjustment amount cannot equal the total servic...
1 Deductible Amount 2 Coinsurance Amount 3 Co-payment Amount 4 The procedure code is inconsistent with the modifier used or a required mo...
1) Aetna: 120 days . 90 Days 2) Amerigroup: 180 days. 3) Bcbs: 1yr . 180 days updated. 4) Cigna: 180 days. 5) Humana: 15 mon...