Medical Policy 
Policy Num: 06.001.050
Policy Name: Duplex Sanning
Policy ID: [ 06.001.050][Ar /L M P ][0.00.00]
Last Review: November 14, 2019
Next Review: N/A
Issue: 11:2019
Related Policies:
Archived
DUPLEX SCANNING
| Popultation Reference No. | Populations | Interventions | Comparators | Outcomes |
|---|---|---|---|---|
| 1 | Individuals: |
|
| Relevant outcomes include:
|
Summary
A Duplex scanning is a procedure of tracking by ultrasound that demonstrates the structures in two dimensions and in real time. It shows the blood speed in two directions with a spectral analysis, of the flow in color and its speed.
To perform a Duplex scanning it is necessary to perform a scanning in real time, therefore the billing of a duplex scanning and Doppler ultrasound of the same part of the body represents "unbundling" and does not proceed for payment.
The Duplex scanning should be limited to specific indications. The information required is anatomically accurate. Therefore, the Duplex scanning must not be used for situations in which another diagnostic study is 0recommended.
Objective
In the early stages of ultrasound when technology was not well developed, doppler was used to measure the speed of blood flowing through blood vessels. They emitted ultrasound waves and the receiver picked up echoes, which would be translated into sounds. Depending on the pitch and pattern of the sound the examiner could make out details such as velocity, heart rate etc. A duplex ultrasound combines traditional ultrasound. This uses sound waves that bounce off blood vessels to create two dimension pictures. The information provided is diferent in each study.
Policy Statements
The Duplex scanning in the evaluation of the arterial / venous flow of abdominal, pelvic organs and of the scrotum, proceed for payment when they are performed for one or more of the following indications.
· Evaluation of a patient with symptoms and findings such as epigastric or periumbilical pain after meals which persists for one to three hours associated with weight loss and that is the result of decreased intake that may suggest a chronic intestinal ischemia.
· The evaluation of patients that have received trauma to the abdomen, pelvis or retroperitoneal area and that possibly involves damage to the arterial / venous flow of the abdominal, pelvic or retroperitoneal organs.
· The evaluation of a possible aneurysm of renal artery or another visceral artery
· The evaluation of a patient that not has responded to antihypertensive therapy as a form to eliminate the presence of renovascular disease such as stenosis of the renal artery, fistula, renal arteriovenous or a renal aneurysm as the cause of the uncontrolled hypertension.
· The evaluation of portal hypertension
· In the evaluation of suspicion of embolism, thrombosis, hemorrhage or infarction of the portal vein, the renal vein or renal artery.
· The evaluation of pain or swelling of the content of the scrotum that suggests obstruction in the arterial venous flow of the testicles or related structures.
The Duplex scanning for the evaluation of the flow of the aorta, lower cava vein, iliac or bridges (bypass graft) of these structures proceed for payment when they are performed for one or more of the following indications:
· Confirm the suspicions of an abdominal or iliac aneurysm.
· Monitor the progress of an aortic aneurysm. Usually the monitoring is done every six months.
· Evaluate the patient with symptoms and findings of a thoracic aneurysm. The usual symptoms of this condition are sub external chest pain, back pain and symptoms due to pressure on the trachea, esophagus, laryngeal nerve or superior vein cava.
· Evaluation of patient that presents findings and symptoms of abdominal aneurysm.
· Evaluation of the patient presenting symptoms and findings that suggest an aortic dissection
· Evaluation of the patient with symptoms and findings of intermittent claudication.
· Evaluation of patient with the suspicion of embolism or abdominal or chest thrombosis.
· Evaluation of patients presenting pain on palpation over the iliac vein region that suggests phlebitis or thrombophlebitis of the iliac vein or inferior vena cava.
· Assessment in patient that has received trauma to the anterior thoracic wall and/or abdomen that possibly brings trauma to the aorta, inferior vena cava and/or iliac veins.
· Evaluate the continuity of both venous and prosthetic bridges (bypass graft) after their realization. Usually this evaluation is performed after six weeks, three months and then every six months.
· Monitor areas of several percutaneous interventions including, but not limited to angioplasties, Thrombolysis, atherectomies and/or placement of mesh (stent). Usually this evaluation is performed after six weeks, three months and then every six months.
Policy Guidelines
Duplex scan is performed after physiologic vascular studies show an abnormal parameter.
Benefit Application
BlueCard/National Account Issues
N/A
Background
The evaluation of the patient with vascular disease begins with a thorough history and physical examination and uses noninvasive vascular studies as an adjunct to confirm a clinical diagnosis and further define the level and extent of vascular pathology. Vascular testing may be indicated for patients with suspected arterial or venous disease based upon symptoms (eg, intermittent claudication , extremity pain ), physical examination findings (eg, signs of tissue ischemia, edema), or in patients with risk factors for atherosclerosis (eg, smoking, diabetes mellitus) or other arterial or venous pathology (eg, trauma, peripheral embolism) .
A variety of noninvasive examinations are available to assess the presence and severity of disease. Physiologic tests include segmental limb pressures and the calculation of pressure index values (eg, ankle-brachial index, wrist-brachial index), exercise testing, segmental volume plethysmography, transcutaneous oxygen measurements, and photoplethysmography.
Regulatory Status
N/A
Rationale
Ultrasound is the mainstay for preliminary investigative and noninvasive vascular imaging, with each mode (eg, B-mode, duplex) providing specific information that is useful depending on the vascular disorder.
Population Reference No. 1 Policy Statement
Individuals:
· Who needs a vascular evaluation
| Population Reference No. 1 Policy Statement | [ x] MedicallyNecessary | [ ] Investigational | [ ] Not Medically Necessary |
References
- American Medical Association. (2001). Principles of CPT® Coding (2nd ed).
- Coding and Payment Guide for Radiology Services. (2003). An essential coding, billing, and reimbursement resource for the Radiologist (11th ed.). Ingenix St Anthony Publishing/Medicode.
- Fauci, A. S., Braunwald, E., Isselbacher, K. J., Wilson, J. D., Martin, J. B., Kasper, D. L., Hauser, S. L., & Longo, D. L. (Eds.). Harrison’s principles of internal medicine (14th ed.). New York: McGraw-Hill.
- Hockerberger, R., Marx, J., & Walls, R. (Ed). (2002). Rosen’s emergency medicine: concepts and clinical practice (5th ed.). St. Louis: Mosby, Inc. Used to provide appropriate indication for procedure.
- Johansson, M., Jenson, G., Aurellm, Friberg, P., Herlitz, H., Klingenstierna, H., et al. Evaluation of duplex ultrasound and captopril renography for detection of renovascular hypertension. Kindy Int 2000; 58(2): 774-82.
- Tabers cyclopedic medical dictionary (17th ed.). (1989). Philadelphia: F. A. Davis Company.
- Tierney, L. M., McPhee, S. J., & Papadakis, M. A. (Eds.). (1998). Current medical diagnosis and treatment (37th ed.). Stamford: Appleton & Lange.
- First Coast Servicie Options, Inc L29420 (2010).
- Current Procedural Terminology (2016) American Medical Association
Codes
| CPT | DESCRIPTION | ||
| 93925 | Lower extremity study | ||
| 93926 | Lower extremity study | ||
| 93930 | Upper extremity study | ||
| 93931 | Upper extremity study | ||
| 93970 | Extremity study | ||
| 93971 | Extremity study | ||
| 93975 | DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF ABDOMINAL, PELVIC, SCROTAL CONTENTS AND/OR RETROPERITONEAL ORGANS; COMPLETE STUDY | ||
| 93976 | DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF ABDOMINAL, PELVIC, SCROTAL CONTENTS AND/OR RETROPERITONEAL ORGANS; LIMITED STUDY | ||
| 93978 | DUPLEX SCAN OF AORTA, INFERIOR VENA CAVA, ILIAC VASCULATURE, OR BYPASS GRAFTS; COMPLETE STUDY | ||
| 93979 | DUPLEX SCAN OF AORTA, INFERIOR VENA CAVA, ILIAC VASCULATURE, OR BYPASS GRAFTS; UNILATERAL OR LIMITED STUDY | ||
| 93980 | Penile vascular study | ||
| 93981 | Penile vascular study | ||
| 93990 | Doppler flow testing |
| ICD-10-CM | D72.829 | Elevated white blood cell count, unspecified |
| | D72.89 | Other specified disorders of white blood cells |
| | I10 | Essential (primary) hypertension |
| | I70.1 | Atherosclerosis of renal artery |
| | I72.2 | Aneurysm of renal artery |
| | I72.8 | Aneurysm of other specified arteries |
| | I81 | Portal vein thrombosis |
| | I82.3 | Embolism and thrombosis of renal vein |
| | I85.01 | Esophageal varices with bleeding |
| | I85.00 | Esophageal varices without bleeding |
| | I85.11 | Secondary esophageal varices with bleeding |
| | I85.10 | Secondary esophageal varices without bleeding |
| | K64..5 | Perianal venous thrombosis |
| | K55.0 | Acute vascular disorders of intestine |
| | K55.1 | Chronic vascular disorders of intestine |
| | K76.6 | Portal hypertension |
| | N28.0 | Ischemia and infarction of kidney |
| | N28.82 N28.89 | Megaloureter Other specified disorders of kidney and ureter |
| | R31.9 | Hematuria, unspecified |
| | R31.0 | Gross hematuria |
| | R31.1 | Benign essential microscopic hematuria |
| | N44.00 | Torsion of testis, unspecified |
| | N50.1 | Vascular disorders of male genital organs |
| | G93.3 R53.1 R53.81 R53.83 | Postviral fatigue syndrome Weakness Other malaise Other fatigue |
| | R17 | Unspecified jaundice |
| | R63.4 | Abnormal weight loss |
| | R09.89 | Other specified symptoms and signs involving the circulatory and respiratory systems |
| | R10.9 | Unspecified abdominal pain |
| | R10.11 | Right upper quadrant pain |
| | R10.12 | Left upper quadrant pain |
| | R10.31 | Right lower quadrant pain |
| | R10.32 | Left lower quadrant pain |
| | R10.33 | Periumbilical pain |
| | R10.13 | Epigastric pain |
| | R10.84 | Generalized abdominal pain |
| | R10.10 R10.2 R10.30 | Upper abdominal pain, unspecified Pelvic and perineal pain Lower abdominal pain, unspecified |
| | R16.0 | Hepatomegaly, not elsewhere classified |
| | R16.1 | Splenomegaly, not elsewhere classified |
| | R19.00 | Intra-abdominal and pelvic swelling, mass and lump, unspecified site |
| | R19.01 | Right upper quadrant abdominal swelling, mass and lump |
| | R19.02 | Left upper quadrant abdominal swelling, mass and lump |
| | R19.03 | Right lower quadrant abdominal swelling, mass and lump |
| | R19.04 | Left lower quadrant abdominal swelling, mass and lump |
| | R19.05 | Periumbilic swelling, mass or lump |
| | R19.06 | Epigastric swelling, mass or lump |
| | R19.07 | Generalized intra-abdominal and pelvic swelling, mass and lump |
| | R19.09 | Other intra-abdominal and pelvic swelling, mass and lump |
| | R18.0 | Malignant ascites |
| | R18.8 | Other ascites |
| | R93.5 | Abnormal findings on diagnostic imaging of other abdominal regions, including retroperitoneum |
| | S35.299A | Unspecified injury of branches of celiac and mesenteric artery, initial encounter |
| | S35.299A | Unspecified injury of branches of celiac and mesenteric artery, initial encounter |
| | S35.299A | Unspecified injury of branches of celiac and mesenteric artery, initial encounter |
| | S35.299A | Unspecified injury of branches of celiac and mesenteric artery, initial encounter |
| | S35.219A | Unspecified injury of celiac artery, initial encounter |
| | S35.229A | Unspecified injury of superior mesenteric artery, initial encounter |
| | S35.229A | Unspecified injury of superior mesenteric artery, initial encounter |
| | S35.239A | Unspecified injury of inferior mesenteric artery, initial encounter |
| | S35.299A | Unspecified injury of branches of celiac and mesenteric artery, initial encounter |
| | S35.339A | Unspecified injury of superior mesenteric vein, initial encounter |
| | S35.349A | Unspecified injury of inferior mesenteric vein, initial encounter |
| | S35.319A | Unspecified injury of portal vein, initial encounter |
| | S35.329A | Unspecified injury of splenic vein, initial encounter |
| | S35.8x9A | Unspecified injury of other blood vessels at abdomen, lower back and pelvis level, initial encounter |
| | S35.403A | Unspecified injury of unspecified renal artery, initial encounter |
| | S35.406A | Unspecified injury of unspecified renal vein, initial encounter |
| | S35.8x9A | Unspecified injury of other blood vessels at abdomen, lower back and pelvis level, initial encounter |
| | S35.90xA | Unspecified injury of unspecified blood vessel at abdomen, lower back and pelvis level, initial encounter |
| | Z94.0 | Kidney transplant status |
| | Z94.4 | Liver transplant status |
| | Z94.83 | Pancreas transplant status |
| | Z09 | Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm |
| | Z09 | Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm |
| | I35.0 | Nonrheumatic aortic (valve) stenosis |
| | I70.209 | Unspecified atherosclerosis of native arteries of extremities, unspecified extremity |
| | I70.219 | Atherosclerosis of native arteries of extremities with intermittent claudication, unspecified extremity |
| | I70.229 | Atherosclerosis of native arteries of extremities with rest pain, unspecified extremity |
| | I70.25 | Atherosclerosis of native arteries of other extremities with ulceration |
| | I70.269 | Atherosclerosis of native arteries of extremities with gangrene, unspecified extremity |
| | I70.299 | Other atherosclerosis of native arteries of extremities, unspecified extremity |
| | I71.00 | Dissection of unspecified site of aorta |
| | I71.01 | Dissection of thoracic aorta |
| | I71.02 | Dissection of abdominal aorta |
| | I71.03 | Dissection of thoracoabdominal aorta |
| | I71.2 | Thoracic aortic aneurysm, without rupture |
| | I71.4 | Abdominal aortic aneurysm, without rupture |
| | I71.6 | Thoracoabdominal aortic aneurysm, without rupture |
| | I71.9 | Aortic aneurysm of unspecified site, without rupture |
| | I72.3 | Aneurysm of iliac artery |
| | I73.9 | Peripheral vascular disease, unspecified |
| | I74.0 | Embolism and thrombosis of abdominal aorta |
| | I74.11 | Embolism and thrombosis of thoracic aorta |
| | I74.5 | Embolism and thrombosis of iliac artery |
| | I80.219 | Phlebitis and thrombophlebitis of unspecified iliac vein |
| | I82.220 I82.221 | Acute embolism and thrombosis of inferior vena cava Chronic embolism and thrombosis of inferior vena cava |
| | I95.9 | Hypotension, unspecified |
| | M54.2 | Cervicalgia |
| | M54.6 | Pain in thoracic spine |
| | M54.5 | Low back pain |
| | M79.609 | Pain in unspecified limb |
| | R20.0 R20.1 R20.2 R20.3 R20.8 R20.9 | Anesthesia of skin Hypoesthesia of skin Paresthesia of skin Hyperesthesia Other disturbances of skin sensation Unspecified disturbances of skin sensation |
| | R60.0 R60.1 R60.9 | Localized edema Generalized edema Edema, unspecified |
| | R23.0 | Cyanosis |
| | R23.1 | Pallor |
| | R23.4 | Changes in skin texture |
| | R49.0 | Dysphonia |
| | R49.21 | Hypernasality |
| | R49.22 | Hyponasality |
| | R49.8 | Other voice and resonance disorders |
| | R47.1 | Dysarthria and anarthria |
| | R47.02 R47.81 R47.89 | Dysphasia Slurred speech Other speech disturbances |
| | R09.89 | Other specified symptoms and signs involving the circulatory and respiratory systems |
| | R06.02 | Shortness of breath |
| | R06.1 | Stridor |
| | R05 | Cough |
| | R07.9 | Chest pain, unspecified |
| | R10.9 | Unspecified abdominal pain |
| | R10.11 | Right upper quadrant pain |
| | R10.12 | Left upper quadrant pain |
| | R10.31 | Right lower quadrant pain |
| | R10.32 | Left lower quadrant pain |
| | R10.33 | Periumbilical pain |
| | R10.13 | Epigastric pain |
| | R10.84 | Generalized abdominal pain |
| | R10.10 R10.2 R10.30 | Upper abdominal pain, unspecified Pelvic and perineal pain Lower abdominal pain, unspecified |
| | R19.00 | Intra-abdominal and pelvic swelling, mass and lump, unspecified site |
| | R19.01 | Right upper quadrant abdominal swelling, mass and lump |
| | R19.02 | Left upper quadrant abdominal swelling, mass and lump |
| | R19.03 | Right lower quadrant abdominal swelling, mass and lump |
| | R19.04 | Left lower quadrant abdominal swelling, mass and lump |
| | R19.05 | Periumbilic swelling, mass or lump |
| | R19.06 | Epigastric swelling, mass or lump |
| | R19.07 | Generalized intra-abdominal and pelvic swelling, mass and lump |
| | R19.09 | Other intra-abdominal and pelvic swelling, mass and lump |
| | R93.5 | Abnormal findings on diagnostic imaging of other abdominal regions, including retroperitoneum |
| | S35.00xA | Unspecified injury of abdominal aorta, initial encounter |
| | S35.10xA | Unspecified injury of inferior vena cava, initial encounter |
| | S35.513A | Injury of unspecified iliac artery, initial encounter |
| | S35.516A | Injury of unspecified iliac vein, initial encounter |
| | Z09 | Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm |
| | Z09 | Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm |
| | Z09 | Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm |
Applicable Modifiers
TC,26 and complete
Policy History
| Date | Action | Description |
|---|---|---|
| 11/14/19 | Annual Revision. CPT Changes | CPT range expanded to 93925-93990. Reviewed by the Provider Advisory Committee. No changes in Policy Statement. Policy archived. |
| 11/14/18 | Revision | Evaluated by the Providers Advisory Committee. No changes. |
| 05/10/16 | Revision | |
| 03/15/13 | Revision | |
| 09/08/11 | Revision |