IMAGING
Duplex Scans
Question: Duplex scans can be used to determine the patency of vessels for hemodialysis access. What CPT® codes are used and how are they distinguishable?
Answer: Generally speaking, the extremity duplex scan codes used for hemodialysis access vessel patency are based on whether arteries, veins or both are imaged.
For both arterial inflow and venous outflow report:
93985 – Duplex scan of arterial inflow and venous outflow for preoperative vessel assessment prior to creation of hemodialysis access; complete bilateral study
93986 – Duplex scan of arterial inflow and venous outflow for preoperative vessel assessment prior to creation of hemodialysis access; complete unilateral study
For only upper extremity arteries report:
93930 – Duplex scan of upper extremity arteries or arterial bypass grafts; complete bilateral study
93931 – Duplex scan of upper extremity arteries or arterial bypass grafts; unilateral or limited study
For only extremity veins report:
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
Intravascular Ultrasound (IVUS)
Question: How is IVUS (intravascular ultrasound) reported when performed on bilateral non-coronary vessels?
Answer: Non-coronary IVUS is reported withadd-on codes 37252 and 37253:
+37252 – Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure)
+37253 – Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; each additional noncoronary vessel (List separately in addition to code for primary procedure)
These codes are reported per vessel imaged. Bilateral vessels are still considered separate vessels for this service, and therefore the bilateral concept does not apply. Codes 37252 and 37253 would be reported for IVUS of bilateral vessels. Because these codes are add-on codes, they must be reported in conjunction with the primary procedure code which are listed in the CPT® manual.
Transthoracic Echocardiography (TTE)
Question: Transthoracic echocardiography (TTE) is used for patients with congenital heart defects (CHDs). What factors should be considered in order to select the appropriate CPT® code for this service?
Answer: Codes 93303-93304, 93306-93308 are used to report TTE services:
93303 – Transthoracic echocardiography for congenital cardiac anomalies; complete
93304 – Transthoracic echocardiography for congenital cardiac anomalies; follow-up or limited study
93306 – Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography
93307 – Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, without spectral or color Doppler echocardiography
93308 – Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, follow-up or limited study
According to CPT® Assistant May 2015, codes 93306-93308 should be reported rather than codes 93303-93304 for cases in which “complex congenital heart disease is suspected but not found” or “for simple congenital anomalies such as patent foramen ovale (PFO) or bicuspid aortic valve.” Note these two CHDs were the only conditions specified by name.
TTE with Modifier 22
Question: Can modifier -22 (Increased Procedural Services) be appended to the congenital TTE codes (93303-93304)?
Answer: According to CPT® Assistant December 2013, codes 93303 and 93304 were developed to recognize the additional work of these procedures in comparison to the standard TEE codes. Therefore, the use of modifier 22 is not applicable.
