Documentation and coding for outpatient arterial and venous ultrasounds performed on the same day

Q.

We have a provider that is requesting that an arterial and venous ultrasound be performed on an outpatient for the same date of service. We can’t code CPT^® codes 93923 and 93970 on the same date of service, correct?

A.

Technically you can, but it should not happen often, and medical necessity for both must be very clearly documented. Most, if not all, Medicare local coding determinations (LCD) for venous evaluation includes a statement similar to this one from First Coast (Florida):

“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 must clearly support the medical necessity of both procedures if performed during the same encounter and be available upon request.” The codes and full descriptions are as follows:

93923 Complete bilateral noninvasive physiologic studies of upper or lower extremity arteries, 3 or more levels (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental blood pressure measurements with bidirectional Doppler waveform recording and analysis, at 3 or more levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental volume plethysmography at 3 or more levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental transcutaneous oxygen tension measurements at 3 or more levels), or single level study with provocative functional maneuvers (eg, measurements with postural provocative tests, or measurements with reactive hyperemia)

93970 Duplex scan of upper extremity arteries or arterial bypass grafts; unilateral or limited study