LCD/NCD Portal

L28830 DUPLEX SCANNING

 

 

10/01/2011

 

 

Indications and Limitations of Coverage and/or Medical Necessity

 

Arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs (procedure codes 93975 and 93976)

 

• Medicare may provide coverage for duplex scanning of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs when performed for one or more of the following indications:

o Evaluate patients presenting with signs or symptoms such as epigastric or periumbilical postprandial pains that last for 1-3 hours and/or with associated weight loss resulting from decreased oral intake which may indicate chronic intestinal ischemia.

o Evaluate patients presenting with an acute onset of crampy or steady epigastric and periumbilical abdominal pain combined with minimal or no findings on abdominal examination and a high leukocyte count to rule out acute intestinal ischemia.

o Evaluate a patient who has sustained trauma to the abdominal, pelvic and/or retroperitoneal area resulting in a possible injury to the arterial inflow and/or venous outflow of the abdominal, pelvic and/or retroperitoneal organs.

o Evaluate a suspicion of an aneurysm of the renal artery or other visceral artery based on a patient’s signs and symptoms of abdominal pain or noted as an incidental finding on another radiological examination.

o Evaluate a hypertensive patient who has failed first line antihypertensive drug therapy in order to rule out renovascular disease such as renal artery stenosis, renal arteriovenous fistula, or renal aneurysm as a cause for the uncontrolled hypertension.

o Evaluate a patient with signs and symptoms of portal hypertension.

 These may include abdominal discomfort and distention, abdominal collaterals (caput medusae), abdominal bruit, ascites, encephalopathy, esophageal varices, splenomegaly, etc.

o Evaluate patients suspected of an embolism, thrombosis, hemorrhage or infarction of the portal vein, renal vein and/or renal artery.

 These patients may present with many different symptoms such as:

• Abdominal discomfort.

• Hematuria.

• Cardiac failure.

• Diastolic hypertension.

• Jaundice, fatigue.

• Weakness.

• Malaise, etc.

o Evaluate patients with pain or swelling of scrotal contents which may be as a result of suspected obstruction in arterial inflow or venous outflow to the testicles or related structures.

 The use of duplex scanning of scrotal contents should only be performed after conventional diagnostic test, such as ultrasound, have proven to be “non-definitive.”

o To evaluate patients for complications of transplanted organ: kidney, liver or pancreas.

Aorta, inferior vena cava, iliac vasculature, or bypass grafts (procedure codes 93978 and 93979)

• Medicare may provide coverage for duplex scanning of aorta, inferior vena cava, iliac vasculature, or bypass grafts when performed for one or more of the following indications:

o Confirm a suspicion of an abdominal or iliac aneurysm raised by a physical examination or noted as an incidental finding on another radiological examination.

 The physical examination usually reveals a palpable, pulsatile and nontender abdominal mass.

o Monitor the progression of an abdominal aortic aneurysm.

 It is usually expected that monitoring occurs approximately every six (6) months.

o Evaluate patients presenting with signs and symptoms of a thoracic aneurysm.

 The symptoms usually associated with a thoracic aneurysm are substernal chest pain, back or neck pain described as deep and aching or throbbing as well as symptoms due to:

• Pressure on the trachea (dyspnea, stridor, a brassy cough).

• The esophagus (dysphagia), the laryngeal nerve (hoarseness).

• Superior vena cava (edema in neck and arms, distended neck veins).

o Evaluate patients presenting with signs and symptoms of an abdominal aneurysm.

 The symptoms usually associated with an abdominal aneurysm are:

• Constant pain located in the mid-abdomen, lumbar region or pelvis which can be severe and may be described as having a boring quality.

 A leaking aneurysm is characterized by lower back pain, whereas, acute pain and hypotension usually occur with rupture

o Evaluate a patient presenting with signs and symptoms suggestive of an aortic dissection.

 A patient with an aortic dissection has symptoms such as a sudden onset of severe, continuous tearing or crushing pain in the chest that radiates to the back and is generally unaccompanied by EKG evidence of a myocardial infarction.

 On physical examination, the patient is agitated, has a murmur of aortic regurgitation, asymmetric diminution of arterial pulses and systolic bruits over the areas where the aortic lumen is narrowed

o Initial evaluation of a patient presenting with signs and symptoms such as intermittent claudication in the calf muscles, thighs and/or buttocks, rest pain, weakness in legs or feeling of tiredness in the buttocks, etc. which may suggest occlusive disease of the aorta and iliac arteries.

 The physical examination usually reveals decreased or absent femoral pulses, a bruit over the narrowed artery, and possibly muscle atrophy.

 If severe occlusive disease exists, the patient will have atrophic changes of the skin, thick nails, coolness of the skin with pallor and cyanosis

o Evaluate patients suspected of an abdominal or thoracic arterial embolism or thrombosis.

 These patients usually present with:

• Severe pain in one or both lower extremities.

• Numbness.

• Symmetric weakness of the legs, with absent or severely reduced pulses below the embolism site.

o Evaluate patients presenting with complaints of pain in the calf or thigh, slight swelling in the involved leg, tenderness of the iliac vein, etc. which may suggest phlebitis or thrombophlebitis of the iliac vein or inferior vena cava.

o Evaluate a patient who has sustained trauma to the chest wall and/or abdomen resulting in a possible injury to the aorta, inferior vena cava and/or iliac vasculature.

o Assess the continued patency of both native venous and prosthetic arterial grafts following surgical intervention.

 Usually this is performed at 6 weeks, 3 months, then every six (6) months

o Monitor the sites of various percutaneous interventions, including, but not limited to angioplasty, thrombolysis/thrombectomy, atherectomy, or stent placement.

 Usually this is performed at 6 weeks, 3 months, and then every six (6) months.

• Note: Duplex testing should be reserved for specific indications for which the precise anatomic information obtained by this technique is likely to be useful.

o Therefore, it would be rare to see duplex scanning being performed for conditions in which another diagnostic test is recommended.

 (e.g., an aortic dissection is better diagnosed with a chest x-ray, transesophageal echocardiogram or aortography).

 

 

Coding Information

 

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 Hospital Inpatient (Medicare Part B only)

13x Hospital Outpatient

14x Hospital - Laboratory Services Provided to Non-patients

21x Skilled Nursing - Inpatient (Including Medicare Part A)

22x Skilled Nursing - Inpatient (Medicare Part B only)

23x Skilled Nursing - Outpatient

85x Critical Access Hospital

 

 

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.

 

0920 Other Diagnostic Services - General Classification

0921 Other Diagnostic Services - Peripheral Vascular Lab

0929 Other Diagnostic Services - Other Diagnostic Service

 

 

CPT/HCPCS Codes

 

93975 DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF ABDOMINAL, PELVIC, SCROTAL CONTENTS AND/OR RETROPERITONEAL ORGANS; COMPLETE STUDY

93976 DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF ABDOMINAL, PELVIC, SCROTAL CONTENTS AND/OR RETROPERITONEAL ORGANS; LIMITED STUDY

93978 DUPLEX SCAN OF AORTA, INFERIOR VENA CAVA, ILIAC VASCULATURE, OR BYPASS GRAFTS; COMPLETE STUDY

93979 DUPLEX SCAN OF AORTA, INFERIOR VENA CAVA, ILIAC VASCULATURE, OR BYPASS GRAFTS; UNILATERAL OR LIMITED STUDY

 

 

ICD-9 Codes that Support Medical Necessity

 

Arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs (procedure codes 93975 and 93976)

288.60 LEUKOCYTOSIS, UNSPECIFIED

288.8 OTHER SPECIFIED DISEASE OF WHITE BLOOD CELLS

401.9 UNSPECIFIED ESSENTIAL HYPERTENSION

440.1 ATHEROSCLEROSIS OF RENAL ARTERY

442.1 ANEURYSM OF RENAL ARTERY

442.84 ANEURYSM OF OTHER VISCERAL ARTERY

452 PORTAL VEIN THROMBOSIS

453.3 EMBOLISM AND THROMBOSIS OF RENAL VEIN

456.0 ESOPHAGEAL VARICES WITH BLEEDING

456.1 ESOPHAGEAL VARICES WITHOUT BLEEDING

456.20 ESOPHAGEAL VARICES IN DISEASES CLASSIFIED ELSEWHERE WITH BLEEDING

456.21 ESOPHAGEAL VARICES IN DISEASES CLASSIFIED ELSEWHERE WITHOUT BLEEDING

456.4 SCROTAL VARICES

557.0 ACUTE VASCULAR INSUFFICIENCY OF INTESTINE

557.1 CHRONIC VASCULAR INSUFFICIENCY OF INTESTINE

572.3 PORTAL HYPERTENSION

593.81 VASCULAR DISORDERS OF KIDNEY

593.89 OTHER SPECIFIED DISORDERS OF KIDNEY AND URETER

599.70 HEMATURIA, UNSPECIFIED

599.71 GROSS HEMATURIA

599.72 MICROSCOPIC HEMATURIA

608.20 TORSION OF TESTIS, UNSPECIFIED

608.83 VASCULAR DISORDERS OF MALE GENITAL ORGANS

780.79 OTHER MALAISE AND FATIGUE

782.4 JAUNDICE UNSPECIFIED NOT OF NEWBORN

783.21 LOSS OF WEIGHT

785.9 OTHER SYMPTOMS INVOLVING CARDIOVASCULAR SYSTEM

789.00 ABDOMINAL PAIN UNSPECIFIED SITE

789.01 ABDOMINAL PAIN RIGHT UPPER QUADRANT

789.02 ABDOMINAL PAIN LEFT UPPER QUADRANT

789.03 ABDOMINAL PAIN RIGHT LOWER QUADRANT

789.04 ABDOMINAL PAIN LEFT LOWER QUADRANT

789.05 ABDOMINAL PAIN PERIUMBILIC

789.06 ABDOMINAL PAIN EPIGASTRIC

789.07 ABDOMINAL PAIN GENERALIZED

789.09 ABDOMINAL PAIN OTHER SPECIFIED SITE

789.1 HEPATOMEGALY

789.2 SPLENOMEGALY

789.30 ABDOMINAL OR PELVIC SWELLING MASS OR LUMP UNSPECIFIED SITE

789.31 ABDOMINAL OR PELVIC SWELLING MASS OR LUMP RIGHT UPPER QUARDANT

789.32 ABDOMINAL OR PELVIC SWELLING MASS OR LUMP LEFT UPPER QUADRANT

789.33 ABDOMINAL OR PELVIC SWELLING MASS OR LUMP RIGHT LOWER QUADRANT

789.34 ABDOMINAL OR PELVIC SWELLING MASS OR LUMP LEFT LOWER QUADRANT

789.35 ABDOMINAL OR PELVIC SWELLING MASS OR LUMP PERIUMBILIC

789.36 ABDOMINAL OR PELVIC SWELLING MASS OR LUMP EPIGASTRIC

789.37 ABDOMINAL OR PELVIC SWELLING MASS OR LUMP GENERALIZED

789.39 ABDOMINAL OR PELVIC SWELLING MASS OR LUMP OTHER SPECIFIED SITE

789.51 MALIGNANT ASCITES

789.59 OTHER ASCITES

793.6 NONSPECIFIC (ABNORMAL) FINDINGS ON RADIOLOGICAL AND OTHER EXAMINATION OF ABDOMINAL AREA, INCLUDING RETROPERITONEUM

902.20 INJURY TO CELIAC AND MESENTERIC ARTERIES UNSPECIFIED

902.21 INJURY TO GASTRIC ARTERY

902.22 INJURY TO HEPATIC ARTERY

902.23 INJURY TO SPLENIC ARTERY

902.24 INJURY TO OTHER SPECIFIED BRANCHES OF CELIAC AXIS

902.25 INJURY TO SUPERIOR MESENTERIC ARTERY (TRUNK)

902.26 INJURY TO PRIMARY BRANCHES OF SUPERIOR MESENTERIC ARTERY

902.27 INJURY TO INFERIOR MESENTERIC ARTERY

902.29 INJURY TO OTHER CELIAC AND MESENTERIC ARTERIES

902.31 INJURY TO SUPERIOR MESENTERIC VEIN AND PRIMARY SUBDIVISIONS

902.32 INJURY TO INFERIOR MESENTERIC VEIN

902.33 INJURY TO PORTAL VEIN

902.34 INJURY TO SPLENIC VEIN

902.39 INJURY TO OTHER PORTAL AND SPLENIC VEINS

902.41 INJURY TO RENAL ARTERY

902.42 INJURY TO RENAL VEIN

902.87 INJURY TO MULTIPLE BLOOD VESSELS OF ABDOMEN AND PELVIS

902.9 INJURY TO UNSPECIFIED BLOOD VESSEL OF ABDOMEN AND PELVIS

V42.0 KIDNEY REPLACED BY TRANSPLANT

V42.7 LIVER REPLACED BY TRANSPLANT

V42.83 PANCREAS REPLACED BY TRANSPLANT

V67.00 FOLLOW-UP EXAMINATION FOLLOWING UNSPECIFIED SURGERY

V67.09 FOLLOW-UP EXAMINATION FOLLOWING OTHER SURGERY

 

Aorta, inferior vena cava, iliac vasculature, or bypass grafts (procedure codes 93978 and 93979)

424.1 AORTIC VALVE DISORDERS

440.20 ATHEROSCLEROSIS OF NATIVE ARTERIES OF THE EXTREMITIES UNSPECIFIED

440.21 ATHEROSCLEROSIS OF NATIVE ARTERIES OF THE EXTREMITIES WITH INTERMITTENT CLAUDICATION

440.22 ATHEROSCLEROSIS OF NATIVE ARTERIES OF THE EXTREMITIES WITH REST PAIN

440.23 ATHEROSCLEROSIS OF NATIVE ARTERIES OF THE EXTREMITIES WITH ULCERATION

440.24 ATHEROSCLEROSIS OF NATIVE ARTERIES OF THE EXTREMITIES WITH GANGRENE

440.29 OTHER ATHEROSCLEROSIS OF NATIVE ARTERIES OF THE EXTREMITIES

441.00 DISSECTION OF AORTA ANEURYSM UNSPECIFIED SITE

441.01 DISSECTION OF AORTA THORACIC

441.02 DISSECTION OF AORTA ABDOMINAL

441.03 DISSECTION OF AORTA THORACOABDOMINAL

441.2 THORACIC ANEURYSM WITHOUT RUPTURE

441.4 ABDOMINAL ANEURYSM WITHOUT RUPTURE

441.7 THORACOABDOMINAL ANEURYSM WITHOUT RUPTURE

441.9 AORTIC ANEURYSM OF UNSPECIFIED SITE WITHOUT RUPTURE

442.2 ANEURYSM OF ILIAC ARTERY

443.9 PERIPHERAL VASCULAR DISEASE UNSPECIFIED

444.01 SADDLE EMBOLUS OF ABDOMINAL AORTA

444.09 OTHER ARTERIAL EMBOLISM AND THROMBOSIS OF ABDOMINAL AORTA

444.1 EMBOLISM AND THROMBOSIS OF THORACIC AORTA

444.81 EMBOLISM AND THROMBOSIS OF ILIAC ARTERY

451.81 PHLEBITIS AND THROMBOPHLEBITIS OF ILIAC VEIN

453.2 OTHER VENOUS EMBOLISM AND THROMBOSIS OF INFERIOR VENA CAVA

458.9 HYPOTENSION UNSPECIFIED

723.1 CERVICALGIA

724.1 PAIN IN THORACIC SPINE

724.2 LUMBAGO

729.5 PAIN IN LIMB

782.0 DISTURBANCE OF SKIN SENSATION

782.3 EDEMA

782.5 CYANOSIS

782.61 PALLOR

782.8 CHANGES IN SKIN TEXTURE

784.42 DYSPHONIA

784.43 HYPERNASALITY

784.44 HYPONASALITY

784.49 OTHER VOICE AND RESONANCE DISORDERS

784.51 DYSARTHRIA

784.59 OTHER SPEECH DISTURBANCE

785.9 OTHER SYMPTOMS INVOLVING CARDIOVASCULAR SYSTEM

786.05 SHORTNESS OF BREATH

786.1 STRIDOR

786.2 COUGH

786.50 UNSPECIFIED CHEST PAIN

789.00 ABDOMINAL PAIN UNSPECIFIED SITE

789.01 ABDOMINAL PAIN RIGHT UPPER QUADRANT

789.02 ABDOMINAL PAIN LEFT UPPER QUADRANT

789.03 ABDOMINAL PAIN RIGHT LOWER QUADRANT

789.04 ABDOMINAL PAIN LEFT LOWER QUADRANT

789.05 ABDOMINAL PAIN PERIUMBILIC

789.06 ABDOMINAL PAIN EPIGASTRIC

789.07 ABDOMINAL PAIN GENERALIZED

789.09 ABDOMINAL PAIN OTHER SPECIFIED SITE

789.30 ABDOMINAL OR PELVIC SWELLING MASS OR LUMP UNSPECIFIED SITE

789.31 ABDOMINAL OR PELVIC SWELLING MASS OR LUMP RIGHT UPPER QUARDANT

789.32 ABDOMINAL OR PELVIC SWELLING MASS OR LUMP LEFT UPPER QUADRANT

789.33 ABDOMINAL OR PELVIC SWELLING MASS OR LUMP RIGHT LOWER QUADRANT

789.34 ABDOMINAL OR PELVIC SWELLING MASS OR LUMP LEFT LOWER QUADRANT

789.35 ABDOMINAL OR PELVIC SWELLING MASS OR LUMP PERIUMBILIC

789.36 ABDOMINAL OR PELVIC SWELLING MASS OR LUMP EPIGASTRIC

789.37 ABDOMINAL OR PELVIC SWELLING MASS OR LUMP GENERALIZED

789.39 ABDOMINAL OR PELVIC SWELLING MASS OR LUMP OTHER SPECIFIED SITE

793.6 NONSPECIFIC (ABNORMAL) FINDINGS ON RADIOLOGICAL AND OTHER EXAMINATION OF ABDOMINAL AREA, INCLUDING RETROPERITONEUM

902.0 INJURY TO ABDOMINAL AORTA

902.10 INJURY TO INFERIOR VENA CAVA UNSPECIFIED

902.53 INJURY TO ILIAC ARTERY

902.54 INJURY TO ILIAC VEIN

V67.00 FOLLOW-UP EXAMINATION FOLLOWING UNSPECIFIED SURGERY

V67.09 FOLLOW-UP EXAMINATION FOLLOWING OTHER SURGERY

V67.59 OTHER FOLLOW-UP EXAMINATION

 

 

Documentation Requirements

 

• Medical record documentation maintained by the ordering physician must clearly indicate the medical necessity of the services being billed.

o The results of the study must also be included in the patient’s medical record. This information is normally found in the office/progress notes, hospital notes, and/or test results.

• If the provider of the duplex scan study (ies) is other than the ordering/referring physician, the provider of the service must maintain hard copy documentation of test results and interpretation, along with copies of the ordering/referring physician’s order for the studies.

 

 

Treatment Logic

 

 

Sources of Information and Basis for Decision

 

American Medical Association. (2001). Principles of CPT® Coding (2nd ed).

 

Coding and Payment Guide for Radiology Services. (2003). An essential coding, billing, and reimbursement resource for the Radiologist (11th ed.). Ingenix St Anthony Publishing/Medicode.

 

Fauci, A. S., Braunwald, E., Isselbacher, K. J., Wilson, J. D., Martin, J. B., Kasper, D. L., Hauser, S. L., & Longo, D. L. (Eds.). Harrison’s principles of internal medicine (14th ed.). New York: McGraw-Hill.

 

FCSO LCD 29159, Duplex Scanning, 10/01/2011. The official local coverage determination (LCD) is the version on the Medicare coverage database at www.cms.gov/medicare-coverage-database/.

 

Hockerberger, R., Marx, J., & Walls, R. (Ed). (2002). Rosen’s emergency medicine: concepts and clinical practice (5th ed.). St. Louis: Mosby, Inc. Used to provide appropriate indication for procedure.

 

Johansson, M., Jenson, G., Aurellm, Friberg, P., Herlitz, H., Klingenstierna, H., et al. Evaluation of duplex ultrasound and captopril renography for detection of renovascular hypertension. Kindy Int 2000; 58(2): 774-82.

 

Tabers Cyclopedic Medical Dictionary (17th ed.). (1989). Philadelphia: F. A. Davis Company.

 

Tierney, L. M., McPhee, S. J., & Papadakis, M. A. (Eds.). (1998). Current medical diagnosis and treatment (37th ed.). Stamford: Appleton & Lange.

 

 

AMA CPT Copyright Statement

CPT codes, descriptions and other data only are copyright 2011 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply.

 

 

CMS LCD DUPLEX SCANNING