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.
