Documenting and coding for ABIs, evaluation & management, venous duplex, arterial duplex or non-invasive ultrasound exam

Q.

Could you please provide the CPT^® code for an Ultrasound (US) Leg ABI Screening?

A.

There is no special CPT or HCPCS code for US leg ABI screening. You would assign one of the regular codes depending on what you actually perform. If all you are doing is an ABI, there is no code, instead it would be reported as an E&M if documented. If you are performing a true, venous duplex, assuming all documentation criteria are met, it would be either CPT code 93970 or 93971, if an arterial duplex was performed and documented, options include CPT codes 93925 or 93926.

If a performing a non-invasive physiologic arterial exam, refer to CPT code options 93922–93924. You would report the appropriate CPT code with a screening diagnosis code – Z13.6 It will be denied by Medicare and may be denied by other insurances, so be certain to check policies before performing.