Maximize Duplex Doppler Ultrasound Documentation & Reimbursement

Maximize Duplex Doppler Ultrasound Documentation & Reimbursement Complete documentation of any radiology procedure is the key to appropriate reimbursement. This is especially true for venous duplex Doppler ultrasound exams, where including fewer than the required number of elements for a complete procedure will result in reimbursement for a limited study.

A complete study includes bilateral upper or lower extremity imaging.

Lower extremity studies require documentation of all the following vessels on both legs:

Entire femoral vein
Entire saphenous vein
Entire popliteal vein

The calf veins may also be included, but they are not required for a complete study.

Upper extremity studies require documentation of all the following vessels on both arms:

Subclavian veins
Jugular veins
Axillary veins
Brachial veins
Basilic veins
Cephalic veins

Forearm veins may also be included, but they are not required for a complete study.

A limited study is any exam that does not include all the above-listed vessels. It could also be a unilateral exam, or one done for preoperative venous mapping (e.g., vascular mapping for bypass grafts).

Whether the study is complete or limited, all three duplex techniques must be performed and documented, including:

Gray scale imaging,
Spectral analysis, and
Color Doppler flow.

If any of these techniques is missing, a duplex imaging study was not performed and cannot be billed as such. It is necessary to document all techniques and provide interpretation for each one.

A handy table was produced a few years ago by the Coding Committee of the Radiology Business Management Association (RBMA) and we have reproduced it here. This ‘buzz words’ chart can be very helpful when coding extremity ultrasound exams.

Required Elements for Duplex Imaging
Duplex = Spectral Analysis and Color Flow
Element 1 Imaging	Element 2 Spectral Analysis	Element 3 Color Flow
B-mode	Acceleration Rate	Color Flow
Diagnostic Evaluation	Bandwidth Broadening
Gray Scale	Mono, Bi or Tri
Real-time Imaging	Peak Systolic Velocity
Two-Dimensional Imaging	Phasicity
	Resistive Index (RI)
	Spectral Broadening
	Spectral Doppler
	Velocity
	Pulsed Doppler
	Pulsatility
	Waveform Analysis

Radiologists might also benefit by keeping this list handy, although the best solution to compliant and complete dictation is for them to use a template system. Regardless of the method, documenting all of the required elements of these exams will allow the coding team to maximize reimbursement by coding to the highest level.

The coding for these exams is as follows:

Duplex scan of extremity veins including responses to compression and other maneuvers;
Complete bilateral study	93970
Limited or unilateral study	93971

The coding team should be providing feedback to the radiologists when they see missing elements, to be certain about the extent of the exam. If a complete exam was done but not documented thoroughly, then an addendum to the report could mean additional reimbursement. In addition to correct coding, be sure to check with commercial payers and with your local Medicare carrier to be sure the procedure is considered to be medically necessary under the patient’s circumstances.

Optimizing reimbursement always depends on coordination of the necessary procedural steps, full documentation of those steps, and then a fully trained coding team who are up to date on the latest changes. Subscribe to this blog to stay current with coding and reimbursement changes.

Erin Stephens, CPC, CIRCC is the Sr. Client Manager, Education at Healthcare Administrative Partners.

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