Codapedia is now a division of Find-A-Code

Coverage Criteria for Peripheral Venous Examinations

April 9th, 2018 - Find-A-Code
0 Votes - Sign in to vote or comment.

According to National Government Services LCD L33627, indications for venous examinations are separated into three major categories: deep vein thrombosis (DVT), chronic venous insufficiency, and vein mapping. Studies are medically necessary only if the patient is a candidate for anticoagulation, thrombolysis or invasive therapeutic procedure(s).

Since the signs and symptoms of arterial occlusive disease and venous disease are so divergent, the performance of simultaneous arterial and venous studies during the same encounter should be accompanied by a clear assessment of the clinical need for both studiesConsequently, documentation clearly supporting the medical necessity of both procedures performed during the same encounter must be available in the patient’s medical record. 

Deep Vein Thrombosis (DVT)

The signs and/or symptoms of DVT are relatively non-specific; and due to the risk associated with pulmonary embolism (PE), objective testing is allowed in patients who are candidates for anticoagulation or invasive therapeutic procedures for the following:

These studies are rarely considered medically necessary for the following:

Chronic Venous Insufficiency

Chronic venous insufficiency may be divided into three categories: primary varicose veins, recurrent DVT, and post-thrombotic (post-phlebitic) syndrome. Peripheral venous studies may be indicated for the evaluation of:

Vein Mapping

Mapping the saphenous veins prior to scheduled revascularization procedures is covered by Medicare when it is expected that an autologous vein will be used to help select an optimal native vessel for grafting .

Vein mapping is not always necessary as a routine pre-operative study, and clinical indications should be noted on the request.  

Vein mapping may be performed prior to creating a dialysis fistula. Please see “VI. Vessel Mapping of Vessels for Hemodialysis Access (93970, 93971G0365).”

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

Muscle Testing and Range of Motion Information
November 8th, 2018 - Wyn Staheli, Director of Research
Be sure to understand the unique code requirements for Muscle and Range of Motion Testing.
Medi-Cal Coverage Criteria for Hospital Beds and Accessories
November 7th, 2018 - Raquel Shumway
Medi-Cal coverage of child and adult hospital beds and accessaries. What is covered and what documentation is required.
Are you Ready for CMS' 2019 Medicare Physician Fee Schedule Final Rule?
November 7th, 2018 - Wyn Staheli, Director of Research
The waiting is over, the Final Rule for CMS' 2019 Medicare Physician Fee Schedule (MPFS) is available - all 2,379 pages for those looking for a little light reading. As anticipated, there are some pretty significant changes. Most of us were carefully watching the proposed changes to the Evaluation and ...
How to Use Modifier Indicators with NCCI Edits (2018-10-31)
October 31st, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
To verify if clinical circumstances might justify the use of a modifier when billing code pairs, look at the NCCI edits and the modifier indicator.  Medicare may have restrictions on the use of a modifier used to bypass an edit.  This important part of coding can alert a payer or ...
Anesthesia and Pain Management
October 31st, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Anesthesia and Pain management is under close watch from the OIG according to a report from Anesthesia Business consultants, they stated, "The Health and Human Services Office of Inspector General (HHS OIG) reports in its most recent Semi-annual Report to Congress that in FY 2017 it brought criminal actions against 881 individuals or organizations ...
Common Allergy CPT Codes and MUEs
October 30th, 2018 - Find-A-Code™
Below is a list of common CPT codes for Allergy and Immunology. Each code is listed with the following information: Medicare Unlikely Edits (MUEs) for both a Non-Facility (NF) and Facility (F) setting. Professional/Technical Component (PC/TC) Indicator. Key Indicator or Procedure Code Status Indicator, which is a Medicare assigned "Indicator" to each code in ...
Allergy Testing 10/29/2018
October 29th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Allergy testing may be performed due to exaggerated sensitivity or hypersensitivity.  Using findings based on the patient’s complaint and face-to-face exam. Testing may be required to identify and determine a patient's immunologic sensitivity or reaction to certain allergens using certain CPT codes.  According to CMS, LCD 33261, allergy testing can be ...



About Codapedia & Find-A-Code Contact Us Terms of Use Privacy Policy Advertise with Us

Codapedia™/Find-A-Code™ - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain) - Fax (801) 770-4428

Copyright © 2009-2018 Find A Code, LLC - CPT® copyright American Medical Association