Key Guidelines for Ultrasound Vascular Duplex scan Coding

Correctly coding for non-invasive vascular diagnostic studies means adhering to a strict set of authoritative  guidelines and instruction. You’ve also got to take diagnostic considerations into account to ensure the claim has an optimal chance at reimbursement.
Let’s address the coding mechanics surrounding extracranial artery and extremity vein duplex scans. Ensure your coding workflow is free from any obstruction by adhering to these practical tips and tricks.

Key Criteria Parameters for Duplex Scan Coding

You’ll report extracranial duplex scans using the following codes:

93880 Duplex scan of extracranial arteries; complete bilateral study
93882 unilateral or limited study

You won’t find any guidelines that instruct you on any sort of criteria for reporting 93880- 93882 beyond the scope of what’s needed to report Doppler (duplex) scans.

There are two ways in which your documentation can meet the criteria for duplex scan reporting. The first, and most convenient, method is for the report to simply state that a duplex study was performed. You’ll typically find documentation supporting this in the findings of the dictation report. Otherwise, you’ll need to confirm documentation of two specific terms: color Doppler and spectral Doppler (or spectral analysis). While you’ll need the documentation to support the use of color Doppler specifically, you can rely on the following terms, among others, to be used interchangeably with spectral Doppler:
• Acceleration rate;
• Bandwidth broadening;
• Waveform analysis; and
• Peak systolic velocity.

Note: These criteria apply to reporting for all duplex Doppler studies.

“While there are no strict guidelines in place that determine what constitutes a complete bilateral study outside of bilaterality, this study will typically include an examination of the internal, external, and common carotid arteries in addition to the vertebral arteries,” explains Barry Rosenberg, MD, chief of radiology at United Memorial Medical Center in Batavia, N.Y. Only if two or more of the aforementioned arteries are not included, or the provider indicates other reasons for a limited study, should you consider 93882 reporting for a bilateral service.

LCD considerations: The majority of Medicare Administrative Contractor (MAC) Local Coverage Determinations (LCDs) include most of the generalized diagnoses you might associate with extracranial duplex scans. However, submission of diagnoses such as R51.- Headache and M54.2 Cervicalgia will typically result in a denial from MACs and most commercial payers. Furthermore, cautions Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians, “If the documentation only allows for signs and symptom coding that includes a headache, don’t forget that coding this common symptom will now require a fourth digit.”

Key Factors  for Venous Duplex Scan Reporting

Guidance on reporting for duplex scans of extremity veins is a little more nuanced than what you’ll encounter for extracranial artery duplex scans. On top of the generalized duplex scan guideline reporting, there are a few sets of criteria you should consider for accurate coding of the following services:

93970 Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study
93971 unilateral or limited study

According to the American College of Radiology (ACR) Ultrasound Coding User’s Guide, criteria for 93970 lower extremity reporting includes examination of the common femoral, femoral, proximal deep femoral, great saphenous, and popliteal veins. Examination of calf veins may also be included and should not be considered additional work. Criteria for 93970 upper extremity reporting should include examination of the subclavian, jugular, axillary, brachial, basilic, and cephalic veins. Forearm vein imaging is also included, when performed.

For bilateral services that don’t meet the above criteria, you will code the service as a limited examination, 93971. You will also report 93971 for unilateral (complete or limited) imaging of upper or lower extremity veins. When you have all the criteria for 93970 or 93971 reporting, but the report does not include enough documentation to support a duplex scan, you should first query the provider. If the imaging does not include color or spectral Doppler, you should report the service using 76882 Ultrasound, limited, joint or other nonvascular extremity structure(s) (eg, 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.

LCD considerations: For purely diagnostic purposes, you won’t find any LCD guidelines on primary diagnosis reporting for gen- eralized extremity venous evaluations. However, most MACs and commercial payers require different primary code reporting for 93970 or 93971 when performed for the following reasons:
• Pre-surgical conduit mapping for coronary artery bypass graft procedures
• Pre-surgical vein mapping for peripheral artery bypass
• Vein mapping for dialysis access

For duplex scans of extremity veins performed for pre-surgical conduit mapping for coronary artery bypass graft procedures, list either Z01.810 Encounter for preprocedural cardiovascular examina- tion or Z01.818 Encounter for other preprocedural examination as the primary diagnosis.
For pre-surgical vein mapping for peripheral artery bypass or vein mapping for dialysis access, report Z01.818 as the primary diagnosis. Findings and any other clinical indications should be reported as secondary diagnoses for all three services