Highmark Medicare Services

12102, 12202, 12302, 12501, 12301, 12201

MAC Part A & B

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Article

No

Non-Invasive Peripheral Venous Studies

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Pennsylvania, Maryland, District of Columbia, DELAWARE

07/11/2008

08/01/2008

N/A

Coding Guidelines

The HCPCS/CPT code(s) may be subject to Correct Coding Initiative (CCI) edits.  This information does not take precedence over CCI edits.  Please refer to CCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare.

To report non-invasive peripheral venous studies for select medically necessary preoperative examinations use:

CPT code 93971 - duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study for the following:

• Preoperative examination of potential harvest vein grafts to be used 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.  Use ICD-9 code V72.83 when reporting this procedure.

HCPCS code G0365 – vessel mapping of vessels for hemodialysis for the following:

• Preoperative examination of vessels prior to hemodialysis access site surgery in patients with end stage renal disease. This is a covered service only when the results of the study are necessary to determine appropriate vessel selection (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.  Use ICD-9 code V72.83 when reporting this procedure.

As noted above, correct coding guidelines indicate that code 93971 should be used to report either a limited bilateral or a complete unilateral study (only one service should be reported).

The CPT code 93970 is described as a “complete bilateral study”. The CPT code 93971 states: “unilateral or limited study”. Both codes can be used for bilateral studies; 93970 for complete, and 93971 for limited.  If a complete or limited bilateral study is done on both the upper and the lower extremities, the corresponding code can be reported once for each study performed (i.e., once for the upper extremities and once for the lower extremities).  Providers should append modifier 59, distinct procedural service, to the second code to indicate that two separate, distinct studies were performed.  There should be a separate written report / interpretation for each study performed.

Diagnostic Tests and X-Rays

Refer to LCD L27506 for more information on non-invasive peripheral venous studies.

Refer to LCD L27504 for information regarding noninvasive cerebrovascular arterial studies. 

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