Duplex scanning is sometimes done to find a suitable vein for arterial revascularizations (detection of venous anomalies and defining vein diameter). b. The professional component (93971 - 26) may be billed to Medicare Part B only if the physician personally reviewed the images prior to the surgery and documented the interpretation in the chart.
What is the CPT code for venous mapping?
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.
When is venous mapping indicated in the evaluation of thrombosis?
• 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.
Does Medicare cover varicose vein treatment?
(Note: Intraoperative ultrasound is covered for Medicare members only) 8. Selective catheter placement (CPT 36011) is included in procedures used to treat the varicose veins. 9. A procedure performed on the same vessel, above and below the knee, is considered the same procedure if done within a 3-month period.
What is preoperative vein 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.
What is the ICD 10 code for vein mapping?
Other specified disorders of veins I87. 8 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM I87. 8 became effective on October 1, 2021.
Does Medicare Cover vein mapping?
Vessel mapping of vessels for hemodialysis access is considered for Medicare payment when it is performed preoperatively prior to creation of hemodialysis access using an autogenous hemodialysis conduit, including arterial inflow and venous outflow.
What ICD 10 DX code covers CPT 93971?
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).
What is the CPT code for vein mapping?
The CPT code descriptions for extremity venous duplex scan are 93970 (Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study) and 93971 (Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study).
Does Medicare pay for code 93970?
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).
Does Medicare cover CPT 36468?
Treatment of telangiectases CPT code 36468) is not covered by Medicare.
What is a vein mapping?
Vein Mapping is the process of identifying and measuring of veins in the upper or lower extremities. By measuring the diameter of a particular vein and examining blood flow, the physician is able to determine if a patient is suffering from a condition known as venous insufficiency.
What is the difference between 93922 and 93923?
CPT 93922 is defined as "non-invasive physiologic studies of upper or lower extremity arteries, single level, bilateral (e.g., ankle/brachial indices, Doppler waveform analysis, volume plethysmography, transcutaneous oxygen tension measurement)." CPT 93923 is defined as "non-invasive physiologic studies of upper or ...
What is the difference between 93970 and 93971?
On codes 93970 and 93971, the distinction is greater than just unilateral or bilateral. 93970 is defined as a complete bilateral study, and as such must meet this definition exactly to be reported. 93971 is a unilateral or limited study, and can be used for a limited bilateral service as well as a unilateral.
Does Medicare cover 93702?
POLICY Bioimpedance testing for lymphedema (93702) is non-covered for HMO, PPO, Individual Marketplace, & Elite/ProMedica Medicare Plan. Bioimpedance testing for lymphedema (93702) does not require prior authorization for Advantage.
How do I bill CPT 93970?
When reporting 93970 CPT code, the duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study, and the following must be available in documentation: superficial femoral vein, common femoral vein, more significant saphenous, popliteal veins, and proximal deep femoral ...
What is the difference between CPT code 93923 and 93925?
For example, when an uninterpretable non-invasive physiologic study (CPT code 93922, 93923 or 93924) is performed which results in performing a duplex scan (CPT codes 93925 or 93926), only the duplex scan should be billed.
Document Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
CMS National Coverage Policy
Language quoted from Centers for Medicare and Medicaid Services (CMS). National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy.
Coverage Guidance
Abstract: Non-invasive vascular studies utilize ultrasonic Doppler and physiologic principles to assess irregularities in blood flow in arterial and venous systems. The display may be a two dimensional image with spectral analysis and color flow or a plethysmographic recording.
Document Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
CMS National Coverage Policy
Language quoted from Centers for Medicare and Medicaid Services (CMS), National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy.
Coverage Guidance
Abstract: Non-invasive vascular studies utilize ultrasonic Doppler and physiologic principles to assess irregularities in blood flow in arterial and venous systems. The display may be a two dimensional image with spectral analysis and color flow or a plethysmographic recording.
What is duplex scanning?
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.
Is it necessary to study asymptomatic varicose veins?
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.
Is bilateral limb edema considered a venous study?
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:
General Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
CMS National Coverage Policy
Title XVIII of the Social Security Act, Section 1833 (e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period..
Article Guidance
This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD), L35451 Non-Invasive Peripheral Venous Studies.
ICD-10-CM Codes that Support Medical Necessity
It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim (s) submitted.
ICD-10-CM Codes that DO NOT Support Medical Necessity
All ICD-10 codes not listed under the "ICD-10 Codes that Support Medical Necessity" section of this article.
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 article does not apply to that Bill Type.
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 article, services reported under other Revenue Codes are equally subject to this coverage determination.
pre-op vein mapping (ERFA)
I am hoping for your feedback regarding pre-operative vein mapping for ERFA. Patients presents to general surgeon for initial visit with subsequent diagnostic Duplex performed by vascular specialty (i.e. 93970).
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