Table of Contents

Basics about CPT code 93970 & 93971

An ultrasound study is performed to evaluate veins in the extremities. For coding 93970 & 93971, a duplex scan is performed which used both B-mode and Doppler studies. A B-mode transducer is placed on the skin and real-time images of the veins are obtained. A Doppler probe within the B-mode transducer provides information on the pattern and direction of blood flow in the veins. The B-mode transducer produces ultrasonic sound waves that move through the skin and bounce off the veins when the probe is moved over the region being studied.

The ultrasound machine creates high-energy sound waves (ultrasound) that are bounced off internal tissues and make echoes. The patterns of these echoes form an image, which is then shown on the screen of the machine. Spectral Doppler analysis is performed to provide information on anatomy and hemodynamic function. The physician reviews the duplex scan and provides a written interpretation of findings.

Assign CPT code 93970 for a complete bilateral study of the upper or lower extremity veins. Assign code 93971 for a unilateral or limited study.

Code description of Procedure code 93970 & 93971

93970 – Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study

93971 – Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study

Symptoms of Blood clot of Vein or DVT (Deep vein thrombosis)

Swelling
Pain or tenderness not caused by injury
Skin that is warm to the touch
Redness or discoloration of the skin

Indications for venous examinations are separated into three major categories: deep vein thrombosis (DVT), chronic venous insufficiency, and vein mapping. Studies are medically necessary only if the patient is a candidate for anticoagulation, thrombolysis or invasive therapeutic procedure(s).

Since the signs and symptoms of arterial occlusive disease and venous disease are so divergent, the performance of simultaneous arterial and venous studies during the same encounter should be rare. Consequently, documentation clearly supporting the medical necessity of both procedures performed during the same encounter must be available in the patient’s medical record.

Deep Vein Thrombosis (DVT)

The signs and/or symptoms of DVT are relatively non-specific; and due to the risk associated with pulmonary embolism (PE), objective testing is allowed in patients who are candidates for anticoagulation or invasive therapeutic procedures for the following:

Clinical signs and/or symptoms of DVT including, but not limited to, edema, tenderness, inflammation, and/or erythema;
Clinical signs and/or symptoms of pulmonary embolus (PE) including, but not limited to, hemoptysis, chest pain, and/or dyspnea;
Unexplained lower extremity edema status, post major surgical procedures, trauma, other or progessive illness/condition; and/or
Unexplained lower extremity pain, excluding pain of skeletal origin.

These studies are rarely considered medically necessary for the following:

Bilateral limb edema in the presence of signs and/or symptoms of congestive heart failure, exogenous obesity and/or arthritis; and/or
Follow-up of phlebitis unless signs/symptoms suggest possible extension of thrombus.

Chronic Venous Insufficiency

Chronic venous insufficiency may be divided into three categories: primary varicose veins, recurrent DVT, and post-thrombotic (post-phlebitic) syndrome. Peripheral venous studies may be indicated for the evaluation of:

Venous function in patients with ulceration suspected to be secondary to venous insufficiency when documenting venous valvular incompetence prior to invasive therapeutic intervention;
Varicose veins by themselves do not indicate medical necessity, but medical necessity may be indicated when they are accompanied by significant pain or stasis dermatitis; and/or
Superficial thrombophlebitis involving the proximal thigh (to investigate whether there was thrombus at the saphenofemoral junction that would demand either anticoagulation or surgical ligation).

Procedure code 93970 & 93971 do complement these diagnosis.

Vein Mapping

Mapping the saphenous veins prior to scheduled revascularization procedures is covered by Medicare when it is expected that an autologous vein will be used, but only if there is uncertainty regarding the availability of a suitable vein for by-pass.

Vein mapping is not always necessary as a routine pre-operative study but is medically reasonable when the patient’s clinical evaluation indicates one of the following:

Previous partial harvest of the vein;
Previous thrombophlebitis or DVT in the leg;
Severe varicose veins;
Previous history of vein stripping, ligation, or sclerotherapy;
Obesity to the degree it interferes with clinical determination;

Other examples must clearly be supported by the medical documentation.

Vein mapping may be performed prior to creating a dialysis fistula. Please see “VI. Vessel Mapping of Vessels for Hemodialysis Access (93990/G0365).”

Supply Codes used with CPT code 93970 and 93971

SK062 patient education booklet
SM018 glutaraldehyde 3.4% (Cidex, Maxicide, Wavicide)
SM022 sanitizing cloth-wipe (surface, instruments, equipment)
SA048 pack, minimum multi-specialty visit
SB005 cover-condom, transducer or ultrasound probe
SB006 drape, non-sterile, sheet 40in x 60in
SJ062 ultrasound transmission gel

Different coding examples for 93971 & 93970 CPT code

Scenario 1

If a patient comes with a right leg swelling and the physician performs a Duplex scan of extremity veins of right leg. After finishing the exam, the physician does not find any abnormality in veins.

Since there is no confirm diagnosis, we will report the sign and symptoms as primary diagnosis as per outpatient coding guidelines. Hence, in such scenario, right leg swelling will be reported as primary diagnosis with procedure CPT code 93971-RT.

Scenario 2

If a patient comes with a left leg pain and the physician performs a duplex scan of extremity veins of left leg. After examination, the physician confirms presence of a deep vein thrombosis in the femoral vein.

Since, there is a confirm diagnosis, as per outpatient coding guidelines, the primary diagnosis will be reported with DVT of femoral vein and the Procedure/CPT code will be 93971-LT

Scenario 3

Now, suppose if a patient has a pain in both upper and lower extremities. These are very rare cases. If a patient has both upper and lower extremities pain and the physician performs a bilateral duplex exam for upper and lower extremity vein. Then, here we have to report each extremity separately.

But, since we have only one CPT code 93970 for both upper and lower extremity, we will report 93970 twice with 59 or X{EPSU} modifier to any of the CPT code.

Modifier will tell the payer, the exam is performed on different location and hence both the procedure will be paid from the payer. If missed to add modifier, only one procedure will be paid by the payer.

93970, 93970–59 or X modifier

Scenario 4

This is also a very rare case. If a patient is having pain in right upper arm and on both lower extremity and the physician decides to perform a duplex scan on right upper extremity vein and on both lower extremity veins.

After performing the exam, the physician finds no abnormality in upper extremity but find a vein thrombosis in the femoral right and left vein of lower extremity.

Now, to report above scenario, you have to code concerned diagnosis with the respective CPT codes as shown below.

93971–59 or X modifier, RT ICD 10-M79631

93970 ICD 10 – I82413

59 modifier is reported to low RVU CPT code 93971, to differentiate it from procedure code 93970. Modifier will help to tell the payer, the exam is performed on different location and is not included in the bilateral exam code 93970.

Do and Don’t with CPT code 93970 & 93971

Bypass surgery – Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study (CPT code 93971) is indicated for the preoperative examination of potential harvest vein grafts to be utilized during bypass surgery. This service is considered reasonable and necessary when the results of the study are needed to locate suitable graft vessels. The need for bypass surgery must be determined prior to performance of the test.
Hemodialysis access surgery – Vessel mapping for hemodialysis (HCPCS code G0365) is indicated for the preoperative examination of vessels prior to hemodialysis access site surgery in patients with end stage renal disease (ESRD). This service is considered reasonable and necessary when the results of the study are needed to determine appropriate vessel utilization (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.

References:

http://www.hcpro.com/HIM-254764-859/QA-Correct-coding-for-unilateral-venous-Doppler

http://bioportal.bioontology.org/ontologies/CPT?p

https://www.umiultrasound.com/

https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=52993