Billing and Coding: Non-Invasive Peripheral Venous Vascular and Hemodialysis
Access Studies

The billing and coding information in this article is dependent on the
coverage indications, limitations and/or medical necessity described in the
related LCD.

**Documentation Requirements**  
Adequate documentation is essential for high-quality patient care and to
demonstrate the reasonableness and medical necessity of the study(ies).
Documentation must support the criteria as described in the Coverage
Indications, Limitations, and/or Medical Necessity section of this LCD. There
should be a permanent record of the performed studies and interpretation. The
documentation should include a description of the studies performed and any
contrast media and/or radiopharmaceuticals used. Any known significant patient
reaction or complications should be recorded. Comparison with prior relevant
studies needs to be addressed in the documentation along with both normal and
abnormal findings. Variations from normal should be documented along with
measurements. The report should address or answer any specific clinical
questions. If there are factors that prevent answering the clinical questions,
this should be explained in the documentation. Retention of the ultrasound
examination images should be consistent both with clinical need and with
relevant legal and local health care facility requirements.  
  
If the provider of the study is other than the ordering/referring
physician/nonphysician practitioner, that provider must maintain a copy of the
test results and interpretation, along with copies of the ordering/referring
physician/nonphysician practitioner's order for the studies. This order is
required to provide adequate diagnostic information to the performing
provider. The physician/nonphysician practitioner must state the clinical
indication/medical necessity for the study in his/her order for the test. The
provider is responsible for ensuring the medical necessity of procedures and
maintaining the medical record, which must be available to Medicare upon
request. Results of all testing must be shared with the referring physician.
Non-invasive vascular studies are medically reasonable and medically necessary
only if the outcomes will be utilized in the clinical management of the
patient.  
  
 **Utilization Guidelines**  
Each patient's condition and response to treatment must medically warrant the
number of services reported for payment. Medicare requires the medical
necessity for each study reported to be clearly documented in the patient's
medical record.  
  
Frequency of follow-up studies will be carefully monitored for medical
necessity and it is the responsibility of the physician/provider to maintain
documentation of medical necessity in the patient's medical record.  
  
Generally, it is expected that noninvasive vascular studies would not be
performed more than once in a year, excluding inpatient hospital (21) and
emergency room (23) places of services.  
  
Only one preoperative scan is considered reasonable and necessary for
hemodialysis access site surgery. If a more current preoperative scan is
indicated for a patient with multiple comorbidities having difficulty being
stabilized for surgery or a change in condition, the medical record would need
to support the medical necessity of the second scan.  
  
Only one limited study is considered reasonable and necessary post operatively
within 72 hours of a saphenous vein ablation, whether surgery is performed on
one side or bilaterally.  
  
Pre-surgical conduit mapping of the radial artery(ies) should only be
accompanied by vein-mapping studies when the arterial studies demonstrate a
non-acceptable conduit, or an insufficient conduit is available for multiple
bypass procedures.  
  
Duplex scanning and physiologic studies may be reimbursed during the same
encounter if the physiologic studies are abnormal and/or to evaluate vascular
trauma, thromboembolic events or aneurysmal disease. The documentation must
support the medical necessity.  
  
Documentation must be provided supporting the need for more than one imaging
study Doppler flow or vessel mapping and arteriogram.  
  
Performance of both non-invasive extracranial arterial studies and non-
invasive evaluation of extremity veins during the same encounter is not
appropriate as a general practice or standing protocol, and therefore,
generally would not be expected to be done together. Consequently,
documentation must clearly support the medical necessity if both procedures
are performed during the same encounter.  
  
Preventive and/or screening services unless covered in Statute are not covered
by Medicare.