Preoperative Examinations

Non-Invasive Peripheral Venous Studies may also be medically necessary for select preoperative examinations.

•    Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study (CPT code 93971) is indicated for the preoperative examination of potential harvest vein grafts to be utilized during bypass surgery. This is a covered service only when the results of the study are necessary to locate suitable graft vessels. The need for bypass surgery must be determined prior to performance of the test. Only one preoperative scan is covered for bypass surgery.

•    Vessel mapping of vessels for hemodialysis (HCPCS code G0365) is indicated for the preoperative examination of vessels prior to hemodialysis access site surgery in patients with end stage renal disease (ESRD). This is a covered service only when the results of the study are necessary to determine appropriate vessel utilization (i.e., when the patient's clinical evaluation does not readily lead to the selection of a vein that is suitable for creating a dialysis fistula). 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.

Limitations

Accuracy of noninvasive vascular diagnostic studies depends on the knowledge, skill, and experience of the technologist and physician performing and interpreting the study. Consequently, the physician performing and/or interpreting the study must be capable of demonstrating documented training and experience and maintain documentation for postpayment audit. A vascular diagnostic study may be personally performed by a physician or a technologist. All noninvasive vascular diagnostic studies performed by a technologist must be performed by, or under the direct supervision of, a technologist who has demonstrated competency by being credentialed in vascular technology, or, such studies must be performed in a facility accredited by the Intersocietal Commission for the Accreditation of Vascular Laboratories (ICAVL) or the Non-Invasive Vascular Ultrasound Accreditation of the American College of Radiology. Examples of appropriate certification include the Registered Vascular Technologist (RVT) credential, the Registered Cardiovascular Technologist (RCVT) credential in Vascular Technology, and the Vascular Sonographer (VS) awarded certification by the ARRT. Direct supervision requires the credentialed individual's presence in the facility and immediate availability to the technologist performing the study.

Medicare does not pay for routine screening tests. ICD-9-CM diagnosis code V82.9 (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 of ICD-9-CM code V82.9 will result in the denial of claims as non-covered screening services.

It is rarely necessary to perform lower extremity and upper extremity studies on the same day. Documentation supporting the need for both studies should be available for review.

As stated above, 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. 

Primary Varicose Veins - It is not medically necessary to study asymptomatic varicose veins. Any preoperative indication not listed as indicated under "Indications and Limitations of Coverage" will be denied based on medical necessity.

The following methods are not covered:

•    Mechanical Oscillometry

•    Inductance Plethysmography

•    Capacitance Plethysmography

•    Photoelectric Plethysmography

Notice: This LCD imposes diagnosis limitations that support diagnosis to procedure code automated denials. However, services performed for any given diagnosis must meet all of the indications and limitations stated in this policy, the general requirements for medical necessity as stated in CMS payment policy manuals, any and all existing CMS national coverage determinations, and all Medicare payment rules.