This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD), L35451 Non-Invasive Peripheral Venous Studies. 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.
To report non-invasive peripheral venous studies for select medically necessary preoperative examinations use:
CPT code 93971 (Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study) for the following:
- Preoperative examination of potential harvest vein grafts to be used during bypass surgery.
- The need for bypass surgery must be determined prior to performance of the test.
- Only one preoperative scan is covered for bypass surgery.
- Use ICD-10-CM code Z01.810 when reporting this procedure.
CPT codes: 93985 (Ultrasound scan of blood flow in extremity on both sides of body for preoperative assessment of blood vessel for dialysis access) and 93986 (Ultrasound scan of blood flow in extremity on one side for preoperative assessment of blood vessel for dialysis access) for the following:
- Preoperative examination of vessels prior to hemodialysis access site surgery in patients with end stage renal disease.
- The need for a hemodialysis access site must be determined prior to performance of the test.
- Only one preoperative scan is covered per hemodialysis access site surgery.
- Use ICD-10-CM code Z01.818 when reporting this procedure with an eligible secondary diagnosis.
As noted above, correct coding guidelines indicate that CPT code 93971 should be used to report either a limited bilateral or a complete unilateral study (only one service should be reported). It would not be appropriate to report -50 modifier with CPT code 93971 for a limited bilateral study.
The CPT code 93970 is described as a “complete bilateral study.” The CPT code 93971 states: “unilateral or limited study.” Both codes can be used for bilateral studies; 93970 for complete, and 93971 for limited. If a complete or limited bilateral study is done on both the upper and the lower extremities, the corresponding code can be reported once for each study performed (i.e., once for the upper extremities and once for the lower extremities). Providers should append modifier 76, repeat service by the same provider, or modifier 77, repeat service by another provider, to the second code to indicate that two separate, distinct studies were performed. There should be a separate written report/interpretation for each study performed.
Note: Effective 1/1/2017, the CPT code 93965 has been deleted with the annual CPT/HCPCS code updates. There is no replacement code for CPT code 93965. It would be inappropriate to report a “not otherwise classified” (NOC) code for this service (Noninvasive physiologic studies of extremity veins, complete bilateral study [eg, doppler waveform analysis with responses to compression and other maneuvers, phleborheography, impedance plethysmography]).
ICD-10-CM diagnosis code Z13.9 (special screening of other conditions, unspecified condition) should be used to indicate screening tests performed in the absence of a specific sign, symptom, or complaint.
Use ICD-10-CM code Z09 only to describe a limited venous duplex (CPT code 93971) performed within 72 hours of a saphenous vein ablation procedure (CPT codes 36473, 36474, 36475, 36476, 36478, 36479, 36482, or 36483).