ARCHIVED

Medical Policy                                           

Policy Num:       06.001.049
Policy Name:    NON INVASIVE VASCULAR STUDIES UPPER AND LOWER EXTREMITIES
Policy ID:          [06.001.049.][Ac/Ar B/L M P ][0.00.00]

Last Review:      November 14, 2018 
Next Review:     N/A 
Issue:                   11:2018

Related Policies:

ARCHIVED

NON INVASIVE VENOUS STUDIES UPPER AND LOWER EXTREMITIES

Summary

Noninvasive vascular studies of the upper and lower extremities veins are used primarily to establish the level or degree of obstructive disease and are necessary if there are findings and symptoms of this and / or the patient is a candidate for invasive treatment of their condition. There are two types  of venous studies:

• Physiological studies - these studies are functional measures including analysis of doppler waveform in response to compression segment, blood pressure measurements, pressure measurements of transcutaneous oxygen plethysmography volume segment determination provocation tests apply and determinations of reactive hyperemia.
• The duplex scanning the upper and lower limbs is an ultrasonic scan where images and structures in two dimensions and in real time are shown, also it includes a spectral analysis with the blood flow velocity.

Objective

The objective of this review is to examine the benefits and possible harms of the non invasive venous studies in the evaluation of chronic venous disease.

Policy Statements

To perform a duplex scanning sweep is needed in real time, therefore the billing of a duplex scanning and ultrasound (Doppler) of the same body part represents "unbundling" and not appropriate as ageneral practice or standing protocol ,and therefore would not be expected. 

The complete physiological study of an extremity includes measures pressure and other physiological studies (eg. Doppler). Duplex scanning and physiological studies are considered for payment  during the same visit only under the following conditions: 

·        If abnormal physiological studies.

·        In the evaluation of vascular trauma.

·        The evaluation of thromboembolic events.

·        The evaluation of aneurysmal disease 

Noninvasive physiological studies of the extremities are considered for payment:

• cases of deep vein thrombophlebitis or if symptoms suggest where the possibility of it, such as pain in the limb without explanation or swelling and / or edema. 

·        patient with symptoms and findings of pulmonary embolism.

·        assessment of symptomatic varicose veins such as pain, swelling and leg ulcers, edema that interferes with daily activities that has not responded to conservative therapy after three months of therapy.

·        The documentation of venous valvular incompetence prior to a therapeutic intervention.

·        The evaluation and selection of a vein to create a fistula or before revascularization.

Given the fact that the symptoms and findings of arterial occlusive disease and venous disease are so divergent that performing arterial and venous studies in the same match is not appropriate for payment.

Extracranial arterial performing studies (CPT 93880 or 93881) and non-invasive evaluation of extremity veins (CPT 93965, 93970 or 93971) during the same encounter is not like widespread protocol therefore do not come for payment.

Policy Guidelines

N/A

Benefit Application

BlueCard/National Account Issues

N/A

Background

 Severe clinical manifestations of chronic venous disease, including edema (which can be unilateral), skin changes, and venous ulceration, are often sufficient to establish a diagnosis of chronic venous insufficiency. However, objective testing may be needed to confirm the diagnosis, determine the etiology (reflux, obstruction, or reflux and obstruction), localize the anatomic site and severity of disease, or identify coexisting peripheral artery disease.

Regulatory Status

Does not apply

Rationale

Text

Population Reference No. 1 Policy Statement

Individuals :

·         Venous vascular disease

Supplemental Information

N/A

Practice Guidelines and Position Statements

N/A

Medicare National Coverage

N/A

References

1. Abuhamad, A., Benacerraf, B., Woletz, P., Burke, B. (2004). The accreditation of ultrasound practices – Impact on compliance with minimum performance guidelines. J Ultrasound Med, 23, 1023-1029.
   
   
2. American College of Radiology Practice Guidelines. (2006). ACR Practice guidelines for the performance of peripheral venous ultrasound examination. Retrieved from http://www.acr.org.
   
   
3. Other Contractor’s Policies
   
   
4. Pellerito, J.S. (2001). Current approach to peripheral arterial sonography. Radiologic Clinics of North America. (39), 3. 553-567. This source was used to provide indications.
   
   
5. Society for Vascular Ultrasound–Professional performance guidelines. (2004). Lower extremity venous insufficiency evaluation. (2003). Upper extremity vein mapping. Retrieved July 8, 2005, from http://www.svunet.org/about/positions.
   
   
6. Stanley, D. (2004). The importance of Intersocietal Commission for the accreditation of vascular laboratories (ICAVL) certification for noninvasive peripheral vascular tests: The Tennessee experience. The Journal for Vascular Ultrasound, 28(2), 65-69.
   
   
7. The complete ICAVL standards for accreditation in noninvasive vascular testing. Parts I through VII. (2010). ICAVL Standards. Retrieved from http://icavl.org.

8. First Coast Service Options, inc L29369.

9. Donnelly R, Hinwood D, London NJ. ABC of arterial and venous disease. Non-invasive methods of arterial and venous assessment. BMJ 2000; 320:698.

10. Prandoni P, Lensing AW, Bernardi E, et al. The diagnostic value of compression ultrasonography in patients with suspected recurrent deep vein thrombosis.Thromb Haemost 2002; 88:402.

Codes

Applicable Modifiers

N/A

Policy History