Non-Invasive Peripheral Venous Studies ( L34714 ) Coverage Guidance

Compliance with the provisions in this policy may be monitored and addressed through post payment data analysis and subsequent medical review audits.

Vascular studies include patient care required to perform the studies; supervision of the studies; and interpretation of study results, with copies for patient's records of hard copy output with analysis of all data, including bidirectional vascular flow or imaging when provided. (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 standards.)

The use of a simple hand-held or other Doppler device that does not produce hard copy data 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 reimbursable. Doppler procedures performed with zero-crossers (i.e., analog [strip chart recorder] analysis) are also included in the office visit.

A duplex scan implies an ultrasonic scanning procedure with display of both two-dimensional structure and motion with time, and Doppler ultrasonic signal documentation with spectrum analysis and/or color flow velocity mapping or imaging.

A physiologic study implies functional measurement procedures including Doppler ultrasound studies, blood pressure measurements, transcutaneous oxygen tension measurements, or plethysmography.

Plethysmography implies volume measurement procedures including air, impedance, or strain gauge methods.

Acceptable Procedures for Reimbursement

•    Duplex scan (CPT/HCPCS codes 93970, 93971, G0365)

•    Doppler waveform analysis including responses to compressions and other maneuvers (CPT code 93965)

•    Impedance Plethysmography (CPT code 93965)

•    Air Plethysmography (CPT code 93965)

•    Strain Gauge Plethysmography (CPT code 93965)

Indications

Indications for venous examinations are separated into the following categories: deep vein thrombosis (DVT), chronic venous insufficiency, and preoperative venous mapping for vascular access.

Deep Vein Thrombosis (DVT)

DVT is the most common vascular disorder that develops in hospitalized patients, and can develop after trauma or prolonged immobility (sitting or bedrest). The signs and/or symptoms of DVT are variable and may be absent. Due to the risk associated with pulmonary embolism (PE), objective testing is allowed in patients that are candidates for anticoagulation or invasive therapeutic procedures for the following indications:

•    Clinical signs and/or symptoms of acute or new onset DVT such as extremity swelling, tenderness, inflammation and/or erythema.

•    Investigation for DVT as the source of a documented pulmonary embolism.

•    The index of suspicion is raised for subsequent DVT in individuals with past history of DVT, pulmonary embolus or documented genetic or acquired coagulation factor aberration.

•    Unexplained extremity edema, especially, unilateral, in an individual at risk for DVT (e.g., immobile, status-post major surgical procedure or injury, indwelling vascular catheter or prosthesis, or postpartum)

Bilateral limb edema, especially when signs and/or symptoms of congestive heart failure, exogenous obesity and/or arthritis are present, should rarely be an indication for venous studies.

Chronic Venous Insufficiency

Chronic venous insufficiency may be divided into several categories; objective testing is allowed in candidates for anticoagulation or invasive therapeutic procedures for the following indications:

•    Post-Thrombotic (Post Phlebitic) Syndrome - Evaluation is medically necessary in patients with symptoms of post-thrombotic syndrome.

•    Recurrent DVT - Evaluation is medically necessary in patients with signs or symptoms of recurrent DVT.

•    Objective tests of venous function may be indicated in patients with ulceration, thickening and discoloration suspected to be secondary to venous insufficiency in order to confirm this diagnosis, by documenting venous valvular incompetence, prior to treatment.

Primary Varicose Veins - It is not usually medically necessary to study asymptomatic varicose veins. However, if a great or small saphenous vein undergoes ablation, a duplex scan of the affected side may be reasonable and necessary postoperatively within 72 hours after the procedure, to assess the result of the surgery and the possibility of propagation of a thrombus.