Procedure CODE and Description
93965 - Noninvasive physiologic studies of extremity veins, complete bilateral study (eg, Doppler waveform analysis with responses to compression and other maneuvers, phleborheography, impedance plethysmography)
93970 - Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study
93971 - Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study
G0365 - Vessel mapping of vessels for hemodialysis access (services for preoperative vessel mapping prior to creation of hemodialysis access using an autogenous hemodialysis conduit, including arterial inflow and venous outflow)
Indications for venous examinations are separated into three major categories:
- New-onset deep vein thrombosis.
- Chronic venous insufficiency.
- Preoperative venous mapping
Note: Venous studies are medically necessary only if the patient is a candidate for anticoagulation or invasive therapeutic procedures.
Acute Deep Vein Thrombosis (DVT)
New-onset Deep Vein Thrombosis (DVT) is a common vascular complication developing in hospitalized or otherwise immobilized patients and in persons with hypercoaguable states. Because the signs and/or symptoms of acute DVT may be relatively non-specific, objective testing may be necessary for patients who are candidates for anticoagulation or invasive therapeutic procedures and who have one of the following:
- Exhibit clinical signs and/or symptoms of acute or new-onset DVT such as extremity swelling, tenderness, inflammation and/or erythema.
- Require investigation for DVT as the source of the pulmonary embolus.
- Unexplained lower extremity edema with high pretest probability of DVT (e.g., status post-major surgical procedure 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.
The following is a list of procedures considered reasonable for Medicare reimbursement for the evaluation of new-onset DVT:
- Duplex scan (93970 or 93971).
- Doppler waveform analysis including responses to compression and other maneuvers (93965).
- Impedance plethysmography (93965).
- Air plethysmography (93965).
- Strain gauge plethysmography (93965).
Chronic Venous Insufficiency
Chronic venous insufficiency may be divided into three categories:
- Primary varicose veins.
- Secondary varicose veins.
- Post-thrombotic (post-phlebitic) syndrome.
It is not medically necessary to study asymptomatic varicose veins. Objective tests of venous function may be indicated in patients with ulceration, thickening and discoloration suspected to be secondary to venous insufficiency to confirm the presence of venous valvular incompetence to determine appropriate treatment. Duplex scanning and physiological tests of extremity veins during the same encounter are not reasonable and medically necessary.
Evaluation of post-thrombotic syndrome is medically necessary when there is evidence of acute change in the involved extremity and recurrent DVT is clinically suspected. Frequency of follow-up studies will be carefully monitored for reasonableness and medical necessity.
Preoperative Venous Mapping
Preoperative vein mapping may be covered when necessary to provide information to the surgeon on suitability of veins to be used in the following circumstances:
- In preparation for vein harvesting for Coronary Artery Bypass Graft (CABG) surgery and for peripheral bypass graft surgery.
- In preparation for AV fistula placement for hemodialysis access in patients with end stage renal disease.
Non-invasive peripheral venous studies are covered by Medicare when provided in the following places of service:
- Physician’s office and physician-directed clinic.
- Outpatient and inpatient hospital.
- Nursing facilities.
- Other facilities such as Independent Diagnostic Testing Facilities (IDTFs).
Note: “Mobile” units are not an appropriate place of service for non-invasive peripheral venous studies.
Vascular diagnostic studies may be personally performed by a physician or technologist. The accuracy of non-invasive 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 through recent residency training or post-graduate Continuing Medical Education (CME) and experience and maintain that documentation for postpayment review.
All non-invasive vascular diagnostic studies, when performed by a technologist, must be performed by a technologist who has demonstrated competency in ultrasound by receiving one of the following credentials in vascular ultrasound technology:
- Registered Vascular Specialist (RVS) provided by Cardiovascular Credentialing International (CCI).
- Registered Vascular Technologist (RVT) provided by the American Registry of Diagnostic Medical Sonographers (ARDMS).
- Vascular Sonographer (VS) provided by the American Registry of Radiologic Technologists, Sonography (ARRT)(S).
Alternately, such studies must be performed in a facility or vascular laboratory accredited by one of the following nationally recognized accreditation organizations:
- American College of Radiology (ACR) Vascular Ultrasound Accreditation Program.
- Intersocietal Commission for the Accreditation of Vascular Laboratories (ICAVL).
If a vascular laboratory or facility is accredited, the technologists performing non-invasive peripheral venous studies in that laboratory are considered to have demonstrated competency in vascular ultrasound.
For areas already within TrailBlazer jurisdiction, these credentialing requirements remain unchanged. Otherwise, the effective date for the credentialing requirement is 12/31/2009.
Contractors shall consider a service to be reasonable and necessary if the contractor determines that the service is:
- Safe and effective.
- Not experimental or investigational (exception: routine costs of qualifying clinical trial services with dates of service on or after September 19, 2000, which meet the requirements of the clinical trials NCD are considered reasonable and necessary).
- Appropriate, including the duration and frequency that is considered appropriate for the service, in terms of whether it is:
- Furnished in accordance with accepted standards of medical practice for the diagnosis or treatment of the patient’s condition or to improve the function of a malformed body member.
- Furnished in a setting appropriate to the patient’s medical needs and condition.
- Ordered and furnished by qualified personnel.
- One that meets, but does not exceed, the patient’s medical need.
- At least as beneficial as an existing and available medically appropriate alternative.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
12X, 13X, 18X, 21X, 22X, 23X, 71X, 83X, 85X
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.
CPT/HCPCS Codes
Note:
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Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book. The American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS) require the use of short CPT descriptors in policies published on the Web.
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93965©
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Extremity study - Fee schedule amount - $118.22
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93970©
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Extremity study Fee schedule amount - $183.16
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93971©
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Extremity study Fee schedule amount - $119.18
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G0365
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Vessel mapping hemo access Fee schedule amount - $160.14
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Billing and Coding Guide for CPT 93970 AND 93971
CPT®93970 Duplex scan of extremity veins, including responses to compression and other maneuvers; complete bilateral study
** Use for duplex study of extracranial veins such as jugular veins
CPT®93971 Duplex scan of extremity veins, including responses to compression and other maneuvers; unilateral or limited study
** Use for duplex study of extracranial vein such as jugular vein
Any combination of 93880, 93882 with 93970, 93971, 93925 and 93926 will result in denial of all claims even if otherwise within LCD identified ICD parameters for medical necessity
All denied claims must be appealed for medical review
Billing for monitoring of hemodialysis access using CPT codes for noninvasive vascular studies other than 93990 is considered a misrepresentation of the service actually provided and contractors will consider this action for fraud investigation. They will conduct data analysis on a periodic basis for noninvasive diagnostic studies of the extremities (including CPT codes 93922, 93923, 93924, 93925, 93926, 93930, 93931, 93965, 93970, 93971). Contractors should handle aberrant findings under normal program safeguard processes by taking whatever corrective action is deemed necessary
Do not report 36475, 36476 in conjunction with 36000-36005, 36410, 36425, 36478, 36479, 38204, 75895, 76000, 76001, 76937, 76942, 76998, 77022, 93970, 93971.
In addition, it is not appropriate to bill for extremity venous duplex imaging (93970 – 93971) in conjunction with the EVAT unless a patient requires a diagnostic extremity Doppler ultrasound on the same day as the EVAT, in which case a modifier should be used to signify the provision of a separate and distinct service.
For evaluation of extremity veins for venous incompetence or deep vein thrombosis, use CPT codes 93970, duplex scan of extremity veins; complete bilateral study or 93971, unilateral or limited study. Medicare has created code G0365 to be used for vessel mapping performed in conjunction with the creation of an autogenous hstula for hemodialysis access. The code includes evaluation of the relevant arterial and venous vessels.
The limited venous extremity code (93971) is used for all other vein mapping. Check with your payers for coverage guidelines on this procedure. In some cases it is not paid in the absence of a previous condition such as severe varicose veins or previous deep vein thrombosis.
The following CPT codes are used to describe saphenous vein ablation procedures using the radiofrequency and laser methods: 36475, +36476, 36478 and +36479. The new codes are inclusive of all imaging guidance; ultrasound guidance of these procedures is not separately reportable. Although carrier policies vary, typically, preoperative extremity duplex to identify and characterize the venous incompetence can still be reported separately.
The recommended codes for that procedure are 93970 and 93971 - Duplex scan of extremity veins, depending upon whether the study is complete and bilateral or limited and unilateral.
When spectral and color Doppler evaluation of the extremities is performed, use the appropriate code (93925-93926, 93930-93931, 93970 or 93971) in conjunction with 76881 or 76882.
• DVT:
- Two-point compression ultrasound of the lower extremity to evaluate for DVT would be coded by a limited duplex scan of the extremity veins (93971-26).
Focused DVT study 93971 Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study
Medicare does not pay separately for this service. CPT CODE 93965
Billing for monitoring of hemodialysis access using CPT codes for noninvasive vascular studies other than 93990 is considered a misrepresentation of the service actually provided and contractors will consider this action for fraud investigation. They will conduct data analysis on a periodic basis for noninvasive diagnostic studies of the extremities (including CPT codes 93922, 93923, 93924, 93925, 93926, 93930, 93931, 93965, 93970, 93971).
Contractors should handle aberrant findings under normal program safeguard processes by taking whatever corrective action is deemed necessary .
Indications
Indications for venous examinations are separated into the following categories: deep vein thrombosis (DVT), chronic venous insufficiency, and preoperative venous mapping .
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)
Billing Guide for G0365
Medicare has created code G0365 to be used for vessel mapping performed in conjunction with the creation of an autogenous hstula for hemodialysis access. The code includes evaluation of the relevant arterial and venous vessels. The limited venous extremity code (93971) is used for all other vein mapping. Check with your payers for coverage guidelines on this procedure. In some cases it is not paid in the absence of a previous condition such as severe varicose veins or previous deep vein thrombosis.
To evaluate the functioning of an existing hemodialysis graft or fistula, use CPT code 93990. Medicare has published specific coverage guidelines for this procedure - review the Local Coverage Determination for specifics.
G0365 Vessel mapping of vessels for hemodialysis access (Services for preoperative vessel mapping prior to creation of hemodialysis access using an autogenous hemodialysis conduit, including arterial inflow and venous outflow) $203.38‡ $12.54 $190.84‡ 0267 $190.84
Most contractors cover G0365 for diagnoses of renal failure and/or preoperative examination (V72.83)
Pre-operative examination for potential harvest vein grafts or pre-operative examination of vessel prior to hemodialysis access surgery Z01.818. For codes in the table below that require a 7th character, letter A initial encounter, D subsequent encounter or S sequela may be used.
Coding Guidelines
1. Use the appropriate procedure code and modifiers.
2. Indicate the diagnoses for which the testing is being performed.
3. No paper documentation is required on initial claims submission unless required by an audit or the case deserves special case-by-case review.
Place information on claim form as EMC narrative where indicated in the policy, e.g., follow-up
studies.
4. Upper and lower extremity physiologic studies (CPT-4 codes 93922 and 93923), Lower extremity studies (CPT-4 codes 93925 and 93926), and Upper extremity duplex studies (CPT-4 codes 93930 and 93931)
If studies are performed on the upper and lower extremities on the same day, the services should be submitted on separate detail lines. When claims are submitted electronically, it should be indicated in Item19 of field N-4 (old format) or in record HAO-05 of the National Standard format, that upper AND lower studies were performed. If paper claims are still being submitted, this information must appear on the CMS-1500 claim form.
5. We will not permit separate payment for CPT code 93971 when G0365 is billed, unless CPT code 93971 is being performed for a separately identifiable indication in a different anatomic region. Other imaging studies may not be billed for the same site on the same date of service unless an appropriate “KX” modifier indicating the reason or need for the second imaging study is provided on the claim form.
Supervision:
General Supervision is defined as: "The procedure is furnished under the physician's overall direction and control, but the physician's presence is not required during the performance of the procedure. Under general supervision, the training of the non-physician personnel who actually performs the diagnostic procedure and the maintenance of the necessary equipment and supplies are the continuing responsibility of the physician." (PM B-01-28, April 29, 2001)
CMS has determined the following list of procedures require general physician supervision effective July 1 2001:
93875 & TC, 93880 & TC, 93882 & TC, 93886 & TC, 93888 & TC, 93922 & TC, 93923 & TC, 93924 & TC, 93925 & TC, 93926 & TC, 93930 & TC, 93965 & TC, 93970 & TC, 93971 & TC (PM B-01-28, April 19, 2001)
We will not permit separate payment for CPT code 93971 when G0365 is billed, unless CPT code 93971 is being performed for a separately identifiable indication in a different anatomic region.
Other imaging studies may not be billed for the same site on the same date of service unless an appropriate “KX” modifier indicating the reason or need for the second imaging study is provided on the claim form.
Definitions
A duplex scan is an ultrasonic scanning procedure with display of both two-dimensional structure and motion with time and Doppler ultrasonic signal documentation with spectral analysis and/or color flow velocity mapping or imaging.
Noninvasive physiologic studies are performed using equipment separate and distinct from the duplex scanner. Physiologic studies are functional measurement procedures that include Doppler ultrasound studies, blood pressure measurements, transcutaneous oxygen tension measurements or plethysmography. A complete extremity physiologic study includes pressure measurements and an additional physiologic technique, e.g., Doppler ultrasound study or plethysmography.
Plethysmography implies volume measurement procedures including air impedance or strain gauge methods. Plethysmography involves the measurement and recording (by one of several methods) of changes in the size of a body part as modified by the circulation of blood in that part.
Indications
Non-invasive evaluation of extremity veins will be considered to be medically necessary under any of the following circumstances:
• The patient has deep venous thrombophlebitis or has clinical findings (otherwise unexplained limb pain, swelling) which suggest the possibility of acute deep venous thrombophlebitis.
• The patient presents with signs and symptoms of pulmonary embolism (PE) indicated by dyspnea, chest pain, and/or hemopytsis.
• The patient has acute pulmonary embolism.
• Evaluation of patient with symptomatic varicose veins such as stasis ulcer of the lower leg, significant pain and significant edema that interferes with activities of daily living that have not resolved following three months of conservative therapy, and symptoms are suspected to be secondary to venous insufficiency, and testing is performed to confirm this diagnosis by documenting venous valvular incompetence prior to an invasive therapeutic intervention, which meets criteria for medical necessity as outlined in the LCD for Treatment of varicose veins of the lower extremity.
• The patient has chronic venous insufficiency, post phlebitic syndrome, or lymphedema.
• The patient has sustained trauma and injury of the venous system is suspected, making evaluation of the venous system of extremities necessary.
• Venous mapping for the selection of a vein suitable for creating a dialysis fistula or prior to revascularization.
• Evaluation of possible venous obstruction or thrombosis in hospitalized patients who have recently undergone procedures, which predispose them to thrombosis and who would not have been therapeutically anti-coagulated otherwise (eg, hip replacements, knee replacements).
Venous mapping is not always indicated as a routine pre-operative study. However, this procedure may be useful prior to surgical revascularization or creation of a dialysis fistula as part of the patient’s clinical evaluation in determination of an adequate venous conduit
Limitations
Performance of both physiological testing (CPT code 93965) and duplex scanning (CPT codes 93970 or 93971) of extremity veins during the same encounter is not appropriate as a general practice or standing protocol, and therefore, would not generally be expected (American College of Radiology). Consequently, documentation must clearly support the medical necessity if both procedures are performed during the same encounter, and be available upon request. Note: Reimbursement of physiologic testing will not be allowed after a duplex scanning has been performed.
Since the signs and symptoms of arterial occlusive disease and venous disease are so divergent, the performance of simultaneous arterial and venous studies during the same encounter should be rare. Consequently, documentation must clearly support the medical necessity of both procedures if performed during the same encounter, and be available upon request.
Non-invasive vascular studies are considered medically necessary only if the outcome will potentially impact the clinical course of the patient. For example, if a patient is (or is not) proceeding on to other diagnostic and/or therapeutic procedures regardless of the outcome of non-invasive studies, and non-invasive vascular procedures will not provide any unique diagnostic information that would impact patient management, then the non-invasive procedures are not medically necessary. If it is obvious from the findings of the history and physical examination that the patient is going to proceed to angiography, then non-invasive vascular studies are not medically necessary.
Performance of both non-invasive extracranial arterial studies (CPT codes 93880 or 93882) and non-invasive evaluation of extremity veins (CPT codes 93965, 93970 or 93971) during the same encounter is not appropriate as a general practice or standing protocol, and therefore, would not generally be expected (American College of Radiology, 2010). Consequently, documentation must clearly support the medical necessity if both procedures are performed during the same encounter, and be available upon request.]
When an uninterpretable study results in performing another type of study, only the successful study should be billed. For example, when an uninterpretable non-invasive physiologic study (CPT code 93965) is performed which results in performing a duplex scan (CPT codes 93970 or 93971), only the duplex scan should be billed.
It is not considered medically reasonable and necessary to study asymptomatic varicose veins.
Methods Not Acceptable for Reimbursement
The following methods are not covered per CMS Manual System, Pub 100-03, Medicare National Coverage Determinations, Chapter 1, Section 20.14 as these methods have not yet reached a level of development such as to allow their routine use in the evaluation of suspected peripheral vascular disease.
• Inductance Plethysmography
• Capacitance Plethysmography
• Mechanical Oscillometry
• Photoelectric Plethysmography
ICD-10 Codes that Support Medical Necessity
I26.01 Septic pulmonary embolism with acute cor pulmonale
I26.02 Saddle embolus of pulmonary artery with acute cor pulmonale
I26.09 Other pulmonary embolism with acute cor pulmonale
I26.90 Septic pulmonary embolism without acute cor pulmonale
I26.92 Saddle embolus of pulmonary artery without acute cor pulmonale
I26.99 Other pulmonary embolism without acute cor pulmonale
I48.0 Paroxysmal atrial fibrillation
I48.2 Chronic atrial fibrillation
I48.91 Unspecified atrial fibrillation
180.00 Phlebitis and thrombophlebitis of superficial vessels of unspecified lower extremity
I80.01 Phlebitis and thrombophlebitis of superficial vessels of right lower extremity
I80.02 Phlebitis and thrombophlebitis of superficial vessels of left lower extremity
I80.03 Phlebitis and thrombophlebitis of superficial vessels of lower extremities, bilateral
I80.10 Phlebitis and thrombophlebitis of unspecified femoral vein
I80.11 Phlebitis and thrombophlebitis of right femoral vein
I80.12 Phlebitis and thrombophlebitis of left femoral vein
I80.13 Phlebitis and thrombophlebitis of femoral vein, bilateral
I80.201 Phlebitis and thrombophlebitis of unspecified deep vessels of right lower extremity
I80.202 Phlebitis and thrombophlebitis of unspecified deep vessels of left lower extremity
I80.203 Phlebitis and thrombophlebitis of unspecified deep vessels of lower extremities, bilateral
I80.209 Phlebitis and thrombophlebitis of unspecified deep vessels of unspecified lower extremity
I80.211 Phlebitis and thrombophlebitis of right iliac vein
I80.212 Phlebitis and thrombophlebitis of left iliac vein
I80.213 Phlebitis and thrombophlebitis of iliac vein, bilateral
I80.219 Phlebitis and thrombophlebitis of unspecified iliac vein
I80.221 Phlebitis and thrombophlebitis of right popliteal vein
I80.222 Phlebitis and thrombophlebitis of left popliteal vein
I80.223 Phlebitis and thrombophlebitis of popliteal vein, bilateral
I80.229 Phlebitis and thrombophlebitis of unspecified popliteal vein
I80.231 Phlebitis and thrombophlebitis of right tibial vein
I80.232 Phlebitis and thrombophlebitis of left tibial vein
I80.233 Phlebitis and thrombophlebitis of tibial vein, bilateral
I80.239 Phlebitis and thrombophlebitis of unspecified tibial vein
I80.291 Phlebitis and thrombophlebitis of other deep vessels of right lower extremity
I80.292 Phlebitis and thrombophlebitis of other deep vessels of left lower extremity
I80.293 Phlebitis and thrombophlebitis of other deep vessels of lower extremity, bilateral
I80.299 Phlebitis and thrombophlebitis of other deep vessels of unspecified lower extremity
I80.3 Phlebitis and thrombophlebitis of lower extremities, unspecified
I80.8 Phlebitis and thrombophlebitis of other sites
I82.401 Acute embolism and thrombosis of unspecified deep veins of right lower extremity
I82.402 Acute embolism and thrombosis of unspecified deep veins of left lower extremity
I82.403 Acute embolism and thrombosis of unspecified deep veins of lower extremity, bilateral
I82.409 Acute embolism and thrombosis of unspecified deep veins of unspecified lower extremity
I82.411 Acute embolism and thrombosis of right femoral vein
I82.412 Acute embolism and thrombosis of left femoral vein
I82.413 Acute embolism and thrombosis of femoral vein, bilateral
I82.419 Acute embolism and thrombosis of unspecified femoral vein
I82.421 Acute embolism and thrombosis of right iliac vein
I82.422 Acute embolism and thrombosis of left iliac vein
I82.423 Acute embolism and thrombosis of iliac vein, bilateral
I82.429 Acute embolism and thrombosis of unspecified iliac vein
I82.431 Acute embolism and thrombosis of right popliteal vein
I82.432 Acute embolism and thrombosis of left popliteal vein
I82.433 Acute embolism and thrombosis of popliteal vein, bilateral
I82.439 Acute embolism and thrombosis of unspecified popliteal vein
I82.441 Acute embolism and thrombosis of right tibial vein
I82.442 Acute embolism and thrombosis of left tibial vein
I82.443 Acute embolism and thrombosis of tibial vein, bilateral
I82.449 Acute embolism and thrombosis of unspecified tibial vein
I82.491 Acute embolism and thrombosis of other specified deep vein of right lower extremity
I82.492 Acute embolism and thrombosis of other specified deep vein of left lower extremity
I82.493 Acute embolism and thrombosis of other specified deep vein of lower extremity, bilateral
I82.499 Acute embolism and thrombosis of other specified deep vein of unspecified lower extremity
I82.4Y1 Acute embolism and thrombosis of unspecified deep veins of right proximal lower extremity
I82.4Y2 Acute embolism and thrombosis of unspecified deep veins of left proximal lower extremity
I82.4Y3 Acute embolism and thrombosis of unspecified deep veins of proximal lower extremity, bilateral
I82.4Y9 Acute embolism and thrombosis of unspecified deep veins of unspecified proximal lower extremity
I82.4Z1 Acute embolism and thrombosis of unspecified deep veins of right distal lower extremity
I82.4Z2 Acute embolism and thrombosis of unspecified deep veins of left distal lower extremity
I82.4Z3 Acute embolism and thrombosis of unspecified deep veins of distal lower extremity, bilateral
I82.4Z9 Acute embolism and thrombosis of unspecified deep veins of unspecified distal lower extremity
I82.501 Chronic embolism and thrombosis of unspecified deep veins of right lower extremity
I82.502 Chronic embolism and thrombosis of unspecified deep veins of left lower extremity
I82.503 Chronic embolism and thrombosis of unspecified deep veins of lower extremity, bilateral
I82.509 Chronic embolism and thrombosis of unspecified deep veins of unspecified lower extremity
I82.511 Chronic embolism and thrombosis of right femoral vein
I82.512 Chronic embolism and thrombosis of left femoral vein
I82.513 Chronic embolism and thrombosis of femoral vein, bilateral
I82.519 Chronic embolism and thrombosis of unspecified femoral vein
I82.521 Chronic embolism and thrombosis of right iliac vein
I82.522 Chronic embolism and thrombosis of left iliac vein
I82.523 Chronic embolism and thrombosis of iliac vein, bilateral
I82.529 Chronic embolism and thrombosis of unspecified iliac vein
I82.531 Chronic embolism and thrombosis of right popliteal vein
I82.532 Chronic embolism and thrombosis of left popliteal vein
I82.533 Chronic embolism and thrombosis of popliteal vein, bilateral
I82.539 Chronic embolism and thrombosis of unspecified popliteal vein
I82.541 Chronic embolism and thrombosis of right tibial vein
I82.542 Chronic embolism and thrombosis of left tibial vein
I82.543 Chronic embolism and thrombosis of tibial vein, bilateral
I82.549 Chronic embolism and thrombosis of unspecified tibial vein
many more
ICD-9-CM Codes that Support Medical Necessity
The CPT/HCPCS codes included in this policy will be subjected to “procedure to diagnosis” editing. The following lists include only those diagnoses for which the identified CPT/HCPCS procedures are covered. If a covered diagnosis is not on the claim, the edit will automatically deny the service as not medically necessary.
Medicare is establishing the following limited coverage for HCPCS/CPT codes 93965, 93970, 93971 and G0365:
Covered for:
410.00–410.02 Acute myocardial infarction of anterolateral wall
410.10–410.12 Acute myocardial infarction of other anterolateral wall
410.20–410.22 Acute myocardial infarction of inferolateral wall
410.30–410.32 Acute myocardial infarction of inferoposterior wall
410.40–410.42 Acute myocardial infarction of other inferior wall
410.50–410.52 Acute myocardial infarction of other lateral wall
410.60–410.62 Acute myocardial infarction, true posterior wall infarction
410.70–410.72 Acute myocardial infarction, subendocardial infarction
410.80–410.82 Acute myocardial infarction, other specified sites
411.0–411.1 Other acute and subacute forms of ischemic heart disease
411.81 Acute coronary occlusion without myocardial infarction
411.89 Other acute and subacute forms of ischemic heart disease, other
412 Old myocardial infarction
413.0–413.1 Angina pectoris
414.00–414.07 begin_of_the_skype_highlighting
00–414.07 end_of_the_skype_highlighting Coronary atherosclerosis
414.10–414.12 Aneurysm and dissection of heart
414.8 Other specified forms of chronic ischemic heart disease
415.0 Acute cor pulmonale
415.11–415.12 Pulmonary embolism and infarction
415.19 Other pulmonary embolism and infarction
440.0–440.1 Atherosclerosis
440.20–440.24 Atherosclerosis of native arteries of the extremities
440.29 Other atherosclerosis of native arteries of the extremities
440.30–440.32 Atherosclerosis of bypass graft of the extremities
444.22 Arterial embolism and thrombosis of lower extremity
444.9 Arterial embolism and thrombosis of unspecified artery
Note: Use code 444.9 only for paradoxical embolism.
451.0 Phlebitis and thrombophlebitis of superficial vessels of lower extremities
451.11 Phlebitis and thrombophlebitis of femoral vein
451.19 Phlebitis and thrombophlebitis of other vein, i.e., tibial, popliteal and femoropopliteal
451.2 Phlebitis and thrombophlebitis of lower extremities, unspecified
451.81–451.84 Phlebitis and thrombophlebitis, of other sites
451.89 Phlebitis and thrombophlebitis, other
451.9 Phlebitis and thrombophlebitis of unspecified site
453.2 Embolism and thrombosis of inferior vena cava
453.40–453.42 Venous embolism and thrombosis of deep vessels of lower extremity
453.50–453.52 Chronic venous embolism and thrombosis of deep vessels of lower extremity
453.6 Venous embolism and thrombosis of superficial vessels of lower extremity
453.72–453.76 Chronic venous embolism and thrombosis of other specified vessels
453.79 Chronic venous embolism and thrombosis of other specified veins
453.82–453.86 Acute venous embolism and thrombosis of other specified veins
453.89 Acute venous embolism and thrombosis of other specified veins
454.0–454.2 Varicose vein of lower extremities
454.8 Varicose vein of lower extremities, with other complications
459.10–459.13 Post-phlebitic syndrome
459.19 Post-phlebitic syndrome, with other complication
459.2 Compression of vein
459.30–459.33 Chronic venous hypertension (idiopathic)
459.39 Chronic venous hypertension (idiopathic), with other complications
518.81 Acute respiratory failure
585.3–585.6 Chronic kidney disease (CKD)
671.02 Varicose veins of legs with delivery with postpartum complication
671.20–671.24 Venous complications in pregnancy and the puerperium, superficial thrombophlebitis
671.30–671.31 Venous complications in pregnancy and the puerperium, deep phlebothrombosis, antepartum
671.33 Venous complications in pregnancy and the puerperium, deep phlebothrombosis, antepartum condition or complication
Documentation Requirements
- Documentation supporting the medical necessity should be legible, maintained in the patient's medical record and made available to Medicare upon request.
- In the case of vascular studies and their interpretations, a hard copy (or a soft copy convertible to a hard copy) must be maintained as a permanent record of the study performed and must be of a quality that meets accepted radiologic standards.
- Medical necessity for performance of simultaneous arterial and venous studies should be rare. Subsequently, documentation must clearly support the reasonableness and medical necessity for both procedures performed during the same encounter.
