HAP Radiology Billing and Coding Blog

Maximize Duplex Doppler Ultrasound Documentation & Reimbursement

Posted: By Erin Stephens on July 6, 2023

Maximize Duplex Doppler Ultrasound Documentation & ReimbursementComplete 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.


View a recording of our webinar 2023 Updates to the MPFS & Radiology  Reimbursement Impact


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


Element 2

Spectral Analysis

Element 3

Color Flow


Acceleration Rate

Color Flow

Diagnostic Evaluation

Bandwidth Broadening


Gray Scale

Mono, Bi or Tri


Real-time Imaging

Peak Systolic Velocity


Two-Dimensional Imaging




Resistive Index (RI)



Spectral Broadening



Spectral Doppler






Pulsed Doppler






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


Limited or unilateral study



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.

Contact HAP

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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Topics: radiology reimbursement, radiology documentation, ultrasound

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