Radiology Question for the Week of April 30, 2018

Question:

We are interested in developing an order set with specific codes when providers want to rule out obstruction of arteries and veins prior to heart catheterization. Which of the following would make more sense?

• Order/charge out arterial duplex/venous duplex with reduced modifiers since they are only looking at the groins.
• Use a “pre-line” order that involves the internal jugular vein, subclavian vein, and common femoral vein but eliminates the jugular and subclavian veins and adds the common femoral arteries.

Answer:

Since there are limited duplex scan codes for both extremity arteries and veins, it would not be appropriate to establish an order for the duplex codes with a reduced services modifier (52).

You could set up an order/charge for limited arterial duplex (93926—lower extremities) or 93931 (upper extremities) and/or limited venous duplex (93971—either upper or lower extremities). Be sure to check your local coverage determination (LCD) for limitations and indications for coverage of these exams.

This assumes that the exam is ordered and performed at a separate session from the heart catheterization. When performed at the same session as the heart cath, code 76937 would be reported for ultrasound guidance for vascular access.