ARCHIVED


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Medical Policy                                      

Policy Num:       06.001.047
Policy Name:    
NON-INVASIVE ARTERIAL VASCULAR STUDIES OF UPPER AND LOWER EXTREMITIES
Policy ID:          [06.001.047][Ar /L M+ P ][0.00.00]


Last Review:      October 14, 2022
Next Review:      N/A
Issue:                   10, 2022

Related Policies:

N/A

Archived

NON-INVASIVE ARTERIAL VASCULAR STUDIES OF UPPER AND LOWER EXTREMITIES 

Popultation Reference No. Populations Interventions Comparators Outcomes
1

Individuals ;

·         With suspected peripheral arterial  disease

Interventions of interest are:

·         Non invasive vascular testing

Comparators of interest are :

·         Clinical diagnosis

Relevant outcomes include:

  • Benefits and harms


 

Summary

Non-invasive studies of the arterial system of the upper and lower extremities are used primarily to establish the level or grade of obstructive arterial disease and is considered for payment if there are findings and symptoms of a possible ischemia of the extremity.  It is also considered for payment if the patient is a candidate for invasive treatment of his condition.

 

A history and physical examination that includes the ankle / brachial index can document the presence or absence of ischemic disease in most of the cases.  They should not be used for the monitoring of the medical treatment (e.g. evaluation of pharmacological intervention).  This latter case can be monitored with physical findings and/or progression or improvement of findings and symptoms.  Edema rarely occurs in presence of occlusive disease except in its postoperative period, in association to an inflammatory process or associated to pain at rest.

 

 

There are two types of peripheral arterial studies:

 

  1. Physiological studies - these studies are of functional measures that include analysis of Doppler wave form with response to the compression by segments, blood pressure measurements, measurements of transcutaneous oxygen pressure, plethysmography of volume by segments, determinations with provocation tests and reactive hyperemia determinations;

 

  1. Duplex scanning of the upper and lower extremities - is an ultrasonic scanning where images and structures are shown in two dimensions and in real time.  It also includes a spectral analysis with the speed of the blood flow.

Objective

The objective of this review is to determine if non invasive arterial vascular testing improve the outcomes in chronic arterial disease.

Policy Statements

To perform a Duplex scanning it is necessary to perform a real time scan, therefore the billing of a Duplex scanning and an ultrasound scan (Doppler) of the same part of the body represents "unbundling" and does not proceed for payment.

 

The complete physiological study of an extremity includes the measures of pressure and another of the physiological studies (e.g. Doppler).

 

Duplex scanning and physiological studies will be paid only during the same date encounter under the following conditions:

 

The ankle / brachial index, even though it is required, is not a procedure that proceeds for payment by itself.

Policy Guidelines

See Policy Statatement

Benefit Application

BlueCard/National Account Issues

Background

The need for noninvasive vascular testing to supplement the history and physical examination depends upon the clinical scenario and urgency of the patient's condition. An exhaustive battery of tests is not required in all patients to evaluate their vascular status. In general, only tests that confirm the presence of arterial disease or provide information that will alter the course of treatment should be performed.

Patients can be asymptomatic or have classic symptoms of peripheral artery disease (PAD) such as claudication, or more atypical symptoms. Symptoms vary depending upon the vascular bed affected, the nature and severity of the disease, and the presence and effectiveness of collateral circulation

Noninvasive vascular testing may be performed to:

·    Provide surveillance after vascular intervention.

 

Regulatory Status

N/A

Rationale

Ultrasound is the mainstay for noninvasive vascular imaging, with each mode (eg, B-mode, duplex) providing specific information. Ultrasonography is used to evaluate the location and extent of vascular disease, arterial hemodynamics, and lesion morphology [10].

Real-time ultrasonography uses reflected sound waves (echoes) to produce images and assess blood velocity. Two ultrasound modes are routinely used in vascular imaging: the B (brightness) mode and the Doppler mode (B mode imaging + Doppler flow detection = duplex ultrasound). Duplex ultrasonography has gained a prominent role in the noninvasive assessment of the peripheral vasculature, overcoming the limitations (need for intravenous contrast) of other noninvasive methods and providing precise anatomic localization and accurate grading of lesion severity

 

Population Reference No. 1 Policy Statement

Individuals ;

·         With suspected peripheral arterial  disease

Population Reference No. 1 Policy Statement [ x] MedicallyNecessary [ ] Investigational [ ] Not Medically Necessary


Supplemental Information

N/A

Practice Guidelines and Position Statements

N/A

Medicare National Coverage

N/A

References

1.    West, Frank; Pacific Vascular Laboratories, Noninvasive Vascular Studies: Seguros de Servicios de Salud de Puerto Rico Inc.  April, 1994

2.    http://www.acr.org/departments/econ/members_only/ca/policy_vascular_la.html

3.    Centers for Medicare & Medicaid Services (LCD) 29324

4.    American College of Radiology. (2012). ACR-AIUM-SIR practice guideline for

the performance of physiologic evaluation of extremity arteries. Retrieved from http://www.acr.org/secondarymainmenucategories/quality_safety/guidelines.aspx

5.American College of Radiology. (2012). ACR appropriateness criteria: Follow-up of lower-extremity arterial bypass surgery. Retrieved from http://www.acr.org/ac

6.American College of Radiology. (2012). ACR appropriateness criteria: Recurrent symptoms following lower-extremity angioplasty. Retrieved from http://www.acr.org/ac

Codes

Codes

   
CPT
Description
 
93922

LIMITED BILATERAL NONINVASIVE PHYSIOLOGIC STUDIES OF UPPER OR LOWER EXTREMITY ARTERIES, (EG, FOR LOWER EXTREMITY: ANKLE/ BRACHIAL INDICES AT DISTAL POSTERIOR TIBIAL AND ANTERIOR TIBIAL/ DORSALIS PEDIS ARTERIES PLUS BIDIRECTIONAL, DOPPLER WAVEFORM RECORDING AND ANALYSIS AT 1-2 LEVELS, OR ANKLE/BRACHIAL INDICES AT DISTAL POSTERIOR TIBIAL AND ANTERIOR TIBIAL/DORSALIS PEDIS ARTERIES PLUS VOLUME PLETHYSMOGRAPHY AT 1-2 LEVELS, OR ANKLE/ BRACHIAL INDICES AT DISTAL POSTERIOR TIBIAL AND ANTERIOR TIBIAL/ DORSALIS PEDIS ARTERIES WITH TRANSCUTANEOUS OXYGEN TENSION MEASUREMENTS AT 1-2 LEVELS)

 
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 LEVEL(S), OR SINGLE LEVEL STUDY WITH PROVOCATIVE FUNCTIONAL MANEUVERS (EG, MEASUREMENTS WITH POSTURAL PROVOCATIVE TESTS, OR MEASUREMENTS WITH REACTIVE HYPEREMIA)  
93924

NONINVASIVE PHYSIOLOGIC STUDIES OF LOWER EXTREMITY ARTERIES, AT REST AND FOLLOWING TREADMILL STRESS TESTING, (IE, BIDIRECTIONAL DOPPLER WAVEFORM OR VOLUME PLETHYSMOGRAPHY RECORDING AND ANALYSIS AT REST WITH ANKLE/BRACHIAL INDICES IMMEDIATELY AFTER AND AT TIMED INTERVALS FOLLOWING PERFORMANCE OF A STANDARDIZED PROTOCOL ON A MOTORIZED TREADMILL PLUS RECORDING OF TIME OF ONSET OF CLAUDICATION OR OTHER SYMPTOMS, MAXIMAL WALKING TIME, AND TIME TO RECOVERY) COMPLETE BILATERAL STUDY

 

93925

Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study

 

93926

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

 

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

 

 

ICD-10-CM

(effective 10/1/15)

NUMBER

DESCRIPTION

 

I70.0

Atherosclerosis of aorta

                                                          I70.211
Atherosclerosis of native arteries of extremities with intermittent claudication, right leg
                                                         I70.212
Atherosclerosis of native arteries of extremities with intermittent claudication, left leg
                                                          I70.213 Atherosclerosis of native arteries of extremities with intermittent claudication, bilateral legs
                                                          I70.218
Atherosclerosis of native arteries of extremities with intermittent claudication, other extremity

 

   I70.219

Atherosclerosis of native arteries of extremities with intermittent claudication, unspecified extremity

                                                         I70.221 Atherosclerosis of native arteries of extremities with rest pain, right leg
                                                         I70.222 Atherosclerosis of native arteries of extremities with rest pain, left leg
                                                         I70.223  Atherosclerosis of native arteries of extremities with rest pain, bilateral legs
                                                         I70.228  Arttherosclerosis of native arteries of extremities with rest pain, other extremity

 

  I70.229

Atherosclerosis of native arteries of extremities with rest pain, unspecified extremity

                                                        I70.233 Atherosclerosis of native arteries of right leg with ulceration of ankle

 

I70.25

Atherosclerosis of native arteries of other extremities with ulceration

 

I70.269

Atherosclerosis of native arteries of extremities with gangrene, unspecified extremity

 

I70.399

Other atherosclerosis of unspecified type of bypass graft(s) of the extremities, unspecified extremity

 

I70.499

Other atherosclerosis of autologous vein bypass graft(s) of the extremities, unspecified extremity

 

I70.599

Other atherosclerosis of nonautologous biological bypass graft(s) of the extremities, unspecified extremity

 

I70.92

Chronic total occlusion of artery of the extremities

 

I71.00

Dissection of unspecified site of aorta

 

I71.01 (Deleted on 9/30/22)

Dissection of thoracic aorta

 

I71.02

Dissection of abdominal aorta

 

I71.03

Dissection of thoracoabdominal aorta

 

I72.1

Aneurysm of artery of upper extremity

 

I72.4

Aneurysm of artery of lower extremity

 

I73.00

Raynaud's syndrome without gangrene

 

I73.1

Thromboangiitis obliterans [Buerger's disease]

 

I79.8

Other disorders of arteries, arterioles and capillaries in diseases classified elsewhere

 

I73.9

Peripheral vascular disease, unspecified

 

I74.0

Embolism and thrombosis of abdominal aorta

 

I74.11

Embolism and thrombosis of thoracic aorta

 

I74.2

Embolism and thrombosis of arteries of the upper extremities

 

I74.3

Embolism and thrombosis of arteries of the lower extremities

 

I75.81

Atheroembolism of kidney

 

I75.89

Atheroembolism of other site

 

I77.0

Arteriovenous fistula, acquired

 

I77.1

Stricture of artery

 

I77.2

Rupture of artery

 

I77.4

Celiac artery compression syndrome

 

I76

Septic arterial embolism

 

L97.909

Non-pressure chronic ulcer of unspecified part of unspecified lower leg with unspecified severity

 

L97.109

Non-pressure chronic ulcer of unspecified thigh with unspecified severity

 

L97.209

Non-pressure chronic ulcer of unspecified calf with unspecified severity

 

L97.309

Non-pressure chronic ulcer of unspecified ankle with unspecified severity

 

L97.409

Non-pressure chronic ulcer of unspecified heel and midfoot with unspecified severity

 

L97.509

Non-pressure chronic ulcer of other part of unspecified foot with unspecified severity

 

L97.809

Non-pressure chronic ulcer of other part of unspecified lower leg with unspecified severity

 

L98.419

 

 L98.429

 

L98.499

Non-pressure chronic ulcer of buttock with unspecified severity

Non-pressure chronic ulcer of back with unspecified severity

 Non-pressure chronic ulcer of skin of other sites with unspecified severity

 

I96

Gangrene, not elsewhere classified

 

S45.809A

Unspecified injury of other specified blood vessels at shoulder and upper arm level, unspecified arm, initial encounter

 

S45.209A

Unspecified injury of axillary or brachial vein, unspecified side, initial encounter

 

S45.109A

 

 S45.209A

Unspecified injury of brachial artery, unspecified side, initial encounter

 Unspecified injury of axillary or brachial vein, unspecified side, initial encounter

 

S55.109A

 

  S65.109A

Unspecified injury of radial artery at forearm level, unspecified arm, initial encounter

 Unspecified injury of radial artery at wrist and hand level of unspecified arm, initial encounter

 

S55.009A

 

  S65.009A

Unspecified injury of ulnar artery at forearm level, unspecified arm, initial encounter

 Unspecified injury of ulnar artery at wrist and hand level of unspecified arm, initial encounter

 

S65.209A

 

 S65.309A

Unspecified injury of superficial palmar arch of unspecified hand, initial encounter

 Unspecified injury of deep palmar arch of unspecified hand, initial encounter

 

S65.409A

 

  S65.509A

Unspecified injury of blood vessel of unspecified thumb, initial encounter

 Unspecified injury of blood vessel of unspecified finger, initial encounter

 

S45.809A

 

 

 S55.809A

 

 

 S65.809A

Unspecified injury of other specified blood vessels at shoulder and upper arm level, unspecified arm, initial encounter

 

Unspecified injury of other blood vessels at forearm level, unspecified arm, initial encounter

 

Unspecified injury of other blood vessels at wrist and hand level of unspecified arm, initial encounter

 

S75.009A

Unspecified injury of femoral artery, unspecified leg, initial encounter

 

S75.009A

Unspecified injury of femoral artery, unspecified leg, initial encounter

 

S85.009A

Unspecified injury of popliteal artery, unspecified leg, initial encounter

 

S85.139A

Unspecified injury of anterior tibial artery, unspecified leg, initial encounter

 

S85.169A

Unspecified injury of posterior tibial artery, unspecified leg, initial encounter

 

S95.109A

Unspecified injury of plantar artery of unspecified foot, initial encounter

 

S75.809A

 

  S85.809A

 

 S95.809A

Unspecified injury of other blood vessels at hip and thigh level, unspecified leg, initial encounter

 Unspecified injury of other blood vessels at lower leg level, unspecified leg, initial encounter

 Unspecified injury of other blood vessels at ankle and foot level, unspecified leg, initial encounter

 

T82.390A

Other mechanical complication of aortic (bifurcation) graft (replacement), initial encounter

 

T82.391A

Other mechanical complication of carotid arterial graft (bypass), initial encounter

 

T82.392A

Other mechanical complication of femoral arterial graft (bypass), initial encounter

 

T82.49xA

Other complication of vascular dialysis catheter, initial encounter

 

T82.590A

Other mechanical complication of surgically created arteriovenous fistula, initial encounter

 

T82.591A

Other mechanical complication of surgically created arteriovenous shunt, initial encounter

 

T82.593A

Other mechanical complication of balloon (counterpulsation) device, initial encounter

 

T82.595A

Other mechanical complication of umbrella device, initial encounter

 

T82.598A

Other mechanical complication of other cardiac and vascular devices and implants, initial encounter

 

T85.9xxA

Unspecified complication of internal prosthetic device, implant and graft, initial encounter

 

T82.817A

Embolism of cardiac prosthetic devices, implants and grafts, initial encounter

 

T82.827A

Fibrosis of cardiac prosthetic devices, implants and grafts, initial encounter

 

T82.837A

Hemorrhage of cardiac prosthetic devices, implants and grafts, initial encounter

 

T82.847A

Pain from cardiac prosthetic devices, implants and grafts, initial encounter

 

T82.857A

Stenosis of cardiac prosthetic devices, implants and grafts, initial encounter

 

T82.867A

Thrombosis of cardiac prosthetic devices, implants and grafts, initial encounter

 

T82.897A

Other specified complication of cardiac prosthetic devices, implants and grafts, initial encounter

 

T82.9xxA

Unspecified complication of cardiac and vascular prosthetic device, implant and graft, initial encounter

 

T82.817A

Embolism of cardiac prosthetic devices, implants and grafts, initial encounter

 

T82.827A

Fibrosis of cardiac prosthetic devices, implants and grafts, initial encounter

 

T82.837A

Hemorrhage of cardiac prosthetic devices, implants and grafts, initial encounter

 

T82.847A

Pain from cardiac prosthetic devices, implants and grafts, initial encounter

 

T82.857A

Stenosis of cardiac prosthetic devices, implants and grafts, initial encounter

 

T82.867A

Thrombosis of cardiac prosthetic devices, implants and grafts, initial encounter

 

T82.897A

Other specified complication of cardiac prosthetic devices, implants and grafts, initial encounter

 

T82.9xxA

Unspecified complication of cardiac and vascular prosthetic device, implant and graft, initial encounter

 

T82.818A

Embolism of vascular prosthetic devices, implants and grafts, initial encounter

 

T82.828A

Fibrosis of vascular prosthetic devices, implants and grafts, initial encounter

 

T82.838A

Hemorrhage of vascular prosthetic devices, implants and grafts, initial encounter

 

T82.848A

Pain from vascular prosthetic devices, implants and grafts, initial encounter

 

T82.858A

Stenosis of vascular prosthetic devices, implants and grafts, initial encounter

 

T82.868A

Thrombosis of vascular prosthetic devices, implants and grafts, initial encounter

 

T82.898A

Other specified complication of vascular prosthetic devices, implants and grafts, initial encounter

 

T82.818A

Embolism of vascular prosthetic devices, implants and grafts, initial encounter

 

T82.828A

Fibrosis of vascular prosthetic devices, implants and grafts, initial encounter

 

T82.838A

Hemorrhage of vascular prosthetic devices, implants and grafts, initial encounter

 

T82.848A

Pain from vascular prosthetic devices, implants and grafts, initial encounter

 

T82.858A

Stenosis of vascular prosthetic devices, implants and grafts, initial encounter

 

T82.868A

Thrombosis of vascular prosthetic devices, implants and grafts, initial encounter

 

T82.898A

Other specified complication of vascular prosthetic devices, implants and grafts, initial encounter

 

T82.9xxA

Unspecified complication of cardiac and vascular prosthetic device, implant and graft, initial encounter

 

T85.81xA

Embolism due to internal prosthetic devices, implants and grafts, not elsewhere classified, initial encounter

 

T85.82xA

Fibrosis due to internal prosthetic devices, implants and grafts, not elsewhere classified, initial encounter

 

T85.83xA

Hemorrhage due to internal prosthetic devices, implants and grafts, not elsewhere classified, initial encounter

 

T85.84xA

Pain due to internal prosthetic devices, implants and grafts, not elsewhere classified, initial encounter

 

T85.85xA

Stenosis due to internal prosthetic devices, implants and grafts, not elsewhere classified, initial encounter

 

T85.86xA

Thrombosis due to internal prosthetic devices, implants and grafts, not elsewhere classified, initial encounter

 

T85.89xA

Other specified complication of internal prosthetic devices, implants and grafts, not elsewhere classified, initial encounter

 

T83.81xA

Embolism of genitourinary prosthetic devices, implants and grafts, initial encounter

 

T83.82xA

Fibrosis of genitourinary prosthetic devices, implants and grafts, initial encounter

 

T83.83xA

Hemorrhage of genitourinary prosthetic devices, implants and grafts, initial encounter

 

T83.84xA

Pain from genitourinary prosthetic devices, implants and grafts, initial encounter

 

T83.85xA

Stenosis of genitourinary prosthetic devices, implants and grafts, initial encounter

 

T83.86xA

Thrombosis of genitourinary prosthetic devices, implants and grafts, initial encounter

 

T83.89xA

Other specified complication of genitourinary prosthetic devices, implants and grafts, initial encounter

 

T83.9xxA

Unspecified complication of genitourinary prosthetic device, implant and graft, initial encounter

 

T84.81xA

Embolism due to internal orthopedic prosthetic devices, implants and grafts, initial encounter

 

T84.82xA

Fibrosis due to internal orthopedic prosthetic devices, implants and grafts, initial encounter

 

T84.83xA

Hemorrhage due to internal orthopedic prosthetic devices, implants and grafts, initial encounter

 

T84.84xA

Pain due to internal orthopedic prosthetic devices, implants and grafts, initial encounter

 

T84.85xA

Stenosis due to internal orthopedic prosthetic devices, implants and grafts, initial encounter

 

T84.86xA

Thrombosis due to internal orthopedic prosthetic devices, implants and grafts, initial encounter

 

T84.89xA

Other specified complication of internal orthopedic prosthetic devices, implants and grafts, initial encounter

 

T84.9xxA

Unspecified complication of internal orthopedic prosthetic device, implant and graft, initial encounter

 

T84.81xA

Embolism due to internal orthopedic prosthetic devices, implants and grafts, initial encounter

 

T84.82xA

Fibrosis due to internal orthopedic prosthetic devices, implants and grafts, initial encounter

 

T84.83xA

Hemorrhage due to internal orthopedic prosthetic devices, implants and grafts, initial encounter

 

T84.84xA

Pain due to internal orthopedic prosthetic devices, implants and grafts, initial encounter

 

T84.85xA

Stenosis due to internal orthopedic prosthetic devices, implants and grafts, initial encounter

 

T84.86xA

Thrombosis due to internal orthopedic prosthetic devices, implants and grafts, initial encounter

 

T84.89xA

Other specified complication of internal orthopedic prosthetic devices, implants and grafts, initial encounter

 

T84.9xxA

Unspecified complication of internal orthopedic prosthetic device, implant and graft, initial encounter

 

T85.81xA

Embolism due to internal prosthetic devices, implants and grafts, not elsewhere classified, initial encounter

 

T85.82xA

Fibrosis due to internal prosthetic devices, implants and grafts, not elsewhere classified, initial encounter

 

T85.83xA

Hemorrhage due to internal prosthetic devices, implants and grafts, not elsewhere classified, initial encounter

 

T85.84xA

Pain due to internal prosthetic devices, implants and grafts, not elsewhere classified, initial encounter

 

T85.85xA

Stenosis due to internal prosthetic devices, implants and grafts, not elsewhere classified, initial encounter

 

T85.86xA

Thrombosis due to internal prosthetic devices, implants and grafts, not elsewhere classified, initial encounter

 

T85.89xA

Other specified complication of internal prosthetic devices, implants and grafts, not elsewhere classified, initial encounter

 

T88.8xxA

Other specified complications of surgical and medical care, not elsewhere classified, initial encounter

 

T88.8xxA

Other specified complications of surgical and medical care, not elsewhere classified, initial encounter

 

T88.8xxA

Other specified complications of surgical and medical care, not elsewhere classified, initial encounter

 

D78.11

Accidental puncture and laceration of the spleen during a procedure on the spleen

 

D78.12

Accidental puncture and laceration of the spleen during other procedure

 

E36.11

Accidental puncture and laceration of an endocrine system organ or structure during an endocrine system procedure

 

E36.12

Accidental puncture and laceration of an endocrine system organ or structure during other procedure

 

H59.219

Accidental puncture and laceration of unspecified eye and adnexa during an ophthalmic procedure

 

H59.229

Accidental puncture and laceration of unspecified eye and adnexa during other procedure

 

H95.31

Accidental puncture and laceration of the ear and mastoid process during a procedure on the ear and mastoid process

 

H95.32

Accidental puncture and laceration of the ear and mastoid process during other procedure

 

I97.51

Accidental puncture and laceration of a circulatory system organ or structure during a circulatory system procedure

 

I97.52

Accidental puncture and laceration of a circulatory system organ or structure during other procedure

 

J95.71

Accidental puncture and laceration of a respiratory system organ or structure during a respiratory system procedure

 

J95.72

Accidental puncture and laceration of a respiratory system organ or structure during other procedure

 

K91.71

Accidental puncture and laceration of a digestive system organ or structure during a digestive system procedure

 

K91.72

Accidental puncture and laceration of a digestive system organ or structure during other procedure

 

L76.11

Accidental puncture and laceration of skin and subcutaneous tissue during a dermatologic procedure

 

L76.12

Accidental puncture and laceration of skin and subcutaneous tissue during other procedure

 

M96.820

Accidental puncture and laceration of a musculoskeletal structure during a musculoskeletal system procedure

 

M96.821

Accidental puncture and laceration of a musculoskeletal structure during other procedure

 

N99.71

Accidental puncture and laceration of a genitourinary system organ or structure during a genitourinary system procedure

 

N99.72

Accidental puncture and laceration of a genitourinary system organ or structure during other procedure

 

T88.8xxA

Other specified complications of surgical and medical care, not elsewhere classified, initial encounter

Applicable Modifiers

N/A

Policy History

Date Action Description
10/14/22 Replace policy - coding update only To delete ICD 10 CM: I71.01 eff on 9/30/22
05/05/21 Revision To add diagnosis I70.211,I70.212, I70.213, I70.218, I70.221, I70.222, I70.228
01/20/21 Revision  To add diagnosis I70.223 and I 70.233 to pay

11/14/19

Annual Review.  CPT Added./  Policy Archived

CPT's 93925,93926,93930 and 93931 added to this policy.  Policy archived.  Approved by the Providers Advisory Committee.

11/14/18 Revision New format.  Reviewed by the Providers Advisory Committee. No changes.
06/20/16 Revision  
10/14/14 Revision  
03/25/13 Revision  
08/03/11 Revision