Draft Article - Billing and Coding: Peripheral Venous Ultrasound (DA52993)

CMS National Coverage PolicyInternet Only Manuals (IOMs):CMS IOM Publication 100-04,Medicare Claims Processing Manual,Chapter 4, Section 20.6.2 Use of Modifiers -50, -LT and -RTChapter 12, Section 40.7.B Billing Instructions for Bilateral SurgeriesSocial Security Act (Title XVIII) Standard References: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.Medicare National Correct Coding Initiative (NCCI) Policy Manual:Chapter XI Medicine Evaluation and Management ServicesCode of Federal Regulations (CFR) References:CFR, Title 42, Volume 2, Chapter IV, Part 410.32(a) Ordering diagnostic testsArticle TextThis Billing and Coding Article provides billing and coding guidance for Proposed Local Coverage Determination (LCD) DL35451 Peripheral Venous Ultrasound. Please refer to the LCD for reasonable and necessary requirements.Coding GuidanceNotice:It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier.Note:When an uninterpretable study results in performing another type of study, only the successful study should be billed.Note:Multiple duplex scans plus noninvasive physiologic studies of the upper and lower extremities (93970, 93971, 93922 and 93923) and 93924-93931 cannot be billed on the same day.The use of a simple hand-held or other Doppler device that does not produce hard copy data or that produces a record that does not permit analysis of bidirectional vascular flow, is considered to be part of the physical examination of the vascular system and is not separately reported.CPT code 93971Consistent with the LCD, doppler ultrasound scanning is the current standard for the preoperative evaluation of reflux in patients with chronic venous insufficiency.Correct coding guidelines indicate that CPT code 93971 should be used to report either a limited bilateral or a complete unilateral study. It would not be appropriate to report -50 modifier with CPT code 93971 for a limited bilateral study.Documentation RequirementsAll documentation must be maintained in the patient's medical record and made available to the contractor upon request.Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.Images of all relevant areas, both normal and abnormal, should be recorded and stored in a retrievable format (electronic preferred).A signed final report of the ultrasound findings and impression should be included in the patients medical record and is the definitive documentation of the study. The final report should include but is not limited to the following demographic components:A description of examination findings, using appropriate anatomic and ultrasound terminology. (Use of acronyms and abbreviations should be avoided)The concluding statements or summary of the report should include these components:An impression, conclusion, or summary statementA specific diagnosis or differential diagnosis, if appropriateA recommendation for follow-up studies, if clinically applicableAn accounting of any failure to include standard views or other necessary components (as listed in the appropriate practice parameter)If prior relevant imaging studies were reviewed, a statement of comparison should be includedDetails concerning any provider-to-provider communication in cases in which a delay in communication may have an adverse effect on the patients outcome.An order from the treating physician/nonphysician practitioner as required by CFR, Title 42, Volume 2, Chapter IV, Part 410.32(a) Ordering diagnostic tests.The medical record for patients with known venous thrombosis on therapy should reflect what clinical change occurred and how the change in thrombus burden will alter treatment.