Billing and Coding: Non-Invasive Abdominal / Visceral Vascular 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 procedure(s).
Documentation must support the criteria for coverage 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 imaging studies needs to be addressed in the documentation
along with both normal and abnormal findings. Variations from normal size
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 abdominal/visceral 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 bypass
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.  
  
The frequency of medically necessary follow-up noninvasive abdominal/visceral
vascular studies post-angioplasty is dictated by the vascular distribution
treated.  
  
Preventive and/or screening services unless covered under Statute are not
covered by Medicare.