PEDIATRIC AND CONGENITAL PVD GUIDELINES
GENERAL GUIDELINES
** The Peripheral Vascular Disease Imaging Guidelines are the same for both the pediatric population and the adult population, unless there are specific guidelines listed here in the Pediatric and Congenital Peripheral Vascular Disease Imaging Guidelines.
AORTIC DISORDERS, RENAL VASCULAR DISORDERS, and VISCERAL ARTERY ANEURYSMS
** Thoracic Aortic Disease
o Chest CT (CPT®71260 or CPT®71270), chest CTA (CPT®71275), or chest MRA (CPT®71555) can be used for surveillance or follow-up of thoracic aortic abnormalities in patients with Loeys-Deitz syndrome, Marfan’s syndrome, Takayasu’s arteritis , or Kawasaki syndrome.*
o Less lethal disorders such as Turner syndrome and tuberous sclerosis have also been associated with aortic dissection.*
** Aortic Congenital Vascular Malformations
o Aortic congenital vascular malformations can be seen with chromosomal abnormalities such as Turner syndrome
o Malformations can include aortic coarctation and aortic valve abnormalities.
o Cardiac MRI (CPT®75557 or CPT®75561), chest MRA (CPT®71555), chest CT (CPT®71260), or chest CTA (CPT®71275) may be needed for evaluation.
o Specialist input is helpful in determining the appropriate imaging pathway.
o Coarctation is usually detected at younger ages with blood pressure substantially elevated in one or both upper extremities relative to lower extremity blood pressures. Plain chest x-ray in this syndrome may also demonstrate characteristic “rib notching.”
** Visceral Artery Aneurysms
o These include arteries to the spleen, kidney, liver and intestines
o Aneurysm of these arteries is defined by an increase of more than 50% of the original arterial diameter
o Risk for rupture is high when the aneurysm is greater than 2 cm or is increasing rapidly*
o Vascular specialist consultation is beneficial in order to determine the timeframe to intervention.
o Monitoring by ultrasound or CT with contrast is appropriate, although ultrasound should be attempted first
o Celiac artery aneurysm can be evaluated by CT abdomen with contrast (CPT®74160), CTA abdomen (CPT®74175), or ultrasound (CPT®76700 or CPT®76705).*
o No definitive time period for serial studies has been established.
** Initial evaluation with six month follow-up is reasonable.
** Yearly follow-up in conjunction with vascular specialist consultation should be performed if no significant enlargement is seen.
** Follow-up imaging after stent placement
o No definitive guidelines have been established for follow-up imaging, but it would be reasonable to follow the same time table as for endovascular aortic repair: CTA of abdomen (CPT®74175), MRA of abdomen (CPT®74185), or CT abdomen (CPT®74160) at 1 month, 6 months, and 12 months following stent placement, then every year. An additional study can be done at 3 months if there was evidence of endoleak on the 1 month study.
Showing posts with label CPT code. Show all posts
Showing posts with label CPT code. Show all posts
Saturday, August 27, 2016
Monday, August 22, 2016
CPT code 75574, 75573 and 71725
CT HEART and CORONARY COMPUTED TOMOGRAPHY ANGIOGRAPHY (CCTA)
General
o Certain payers consider coronary calcium scoring and/or cardiac CT and Coronary Computed Tomography Angiography (CCTA) investigational, and their coverage policies will take precedence over MedSolutions' guidelines.
o Most payers require cardiac CT studies to be performed on a 64-slice CT scanner.
o Metal artifact reduces the accuracy of CCTA. Devices that can cause this issue include, but are not limited to, surgical clips, pacemaker devices, defibrillator devices and tissue expanders.
o Cardiac testing that does not involve exposure to ionizing radiation should be strongly considered.
** Multislice CT is associated with a non-neglible risk for cancer, especially in women and younger patients.* *JAMA 2007;298:317-323
o Contraindications to CCTA include:
** Irregular heart rhythms (e.g. atrial fibrillation/flutter, frequent irregular premature ventricular contractions or premature atrial contractions, and high grade heart block)
** Very obese patients (body mass index >40 kg/m2)
** Elevated calcium score
** CCTA should not be performed if there is extensive coronary calcification (calcium score >1000).
** Renal insufficiency
** Inability to follow breath holding instructions
** Heart rate over 75 beats per minute
** Allergy to iodine contrast material
Anomalous Coronary Artery(ies)
o Evaluating coronary artery anomalies and other complex congenital heart disease of cardiac chambers or great vessels is an appropriate indication for CCTA.
** Report CPT®75574 for evaluating coronary artery anomalies
** Report CPT®75573 for congenital heart disease
** Can add CPT®71275 (chest CTA) to evaluate great vessels
** In cases of anomalous pulmonary venous return, can add CT abdomen and pelvis.
The use of CCTA to rule out anomalous coronary artery(ies) should be limited to patients who need to have an anomalous coronary artery mapped prior to an invasive procedure, or who have not had a previous imaging study that clearly demonstrates an anomalous coronary artery and/or shows the anomalous artery to be patent and who are less than age 40 with a history that includes one or more of the following (aortic root echocardiography or cardiac MRI can also be considered to avoid radiation exposure):
** Persistent exertional chest pain and normal stress test
** Full sibling(s) with history of sudden death syndrome before age 30 or with documented anomalous coronary artery
** Resuscitated sudden death and contraindications for conventional coronary angiography
** Unexplained syncope (not presyncope)
** Patients should have had a thorough negative evaluation for syncope as outlined in HD-31 Syncope in the adult Head Imaging Guidelines and PACCD-5 Syncope (e.g. echocardiogram, cardiac evaluation for postural blood pressure changes, resting low blood pressure, or low heart rate, myocardial perfusion imaging study, exercise treadmill test, stress echocardiogram, or stress MRI, consideration for situational syncope) prior to considering CCTA.
** Unexplained new onset of heart failure (e.g. without atherosclerotic coronary artery disease or other known causes for cardiomyopathy) if CCTA will replace conventional invasive coronary angiography.
** Documented ventricular tachycardia (6 beat runs or greater) if CCTA will replace conventional invasive coronary angiography.
** Equivocal coronary artery anatomy on conventional cardiac catheterization
** In infants: otherwise unexplained dyspnea, tachypnea, wheezing, episodic pallor, irritability, sweating, poor feeding, and/or failure to thrive o The presence of other congenital heart disease is not a separate indication for CCTA to rule out anomalous coronary artery(ies).
Other Indications for Cardiac CT/ CCTA:
o Congenital heart disease assessment (with procedures CPT®75573 or CPT®71275) is indicated in both children and adults for the following:
** Determination of extra-cardiac anatomy in patients with complex congenital heart disease
** For example: great vessel relationships, bronchial collateral vessels, abdominal situs, etc.
** Pulmonary artery (PA) and Pulmonary vein assessment:
** Pulmonary artery evaluation in children who need preoperative or postoperative evaluation for PA stenosis or PA atresia
** PA caliber evaluation in children with pulmonary hypoplasia
** PA evaluation to look for another anatomic structure impinging on the PA, or to look for airway/bronchial compromise by an enlarged PA or other mediastinal vessel.
** Assessment of the course of drainage of pulmonary veins when chest x-ray suggests anomalous pulmonary venous drainage.
** Coarctation of the aorta or interruption of the aortic arch suspected on echocardiography.
** Evaluation of the arterial supply and venous drainage in children with bronchopulmonary sequestration.
o Vasculitis/Takayasu's/Kawasaki's disease can be imaged with CCTA (CPT®75574).
o Cardiac CT (CPT®75572) can be used to assess cardiac tumor or mass, pericardial mass, pericarditis/ constrictive pericarditis, complications of cardiac surgery, evaluation of post-operative anatomy and surgically corrected systemic-to-pulmonary artery shunts and intra-cardiac baffles, etc.
o Cardiac CT (CPT®75572) can be used to evaluate cardiac thrombus in patients with technically limited echocardiogram, MRI, or transesophageal echocardiogram.
o Cardiac CT (CPT®75572) can be used to evaluate clinical suspicion of arrhythmogenic right ventricular dysplasia or arrhythmogenic cardiomyopathy (ARVD/ARVC), especially if patient has presyncope or syncope if the clinical suspicion is supported by established criteria for ARVD (see PACCD-3 Evidence Based Clinical Support) or if the patient has documented Brugada’s syndrome.
** If right ventricular abnormalities are already identified by echo or other techniques, cardiac CT may not be necessary.
** Young patients with right bundle branch block, unexplained syncope, and “normal” echo can undergo cardiac MRI (CPT®75557 or CPT®75561) or cardiac CT (CPT®75572) to rule out ARVD/ARVC.
o Native aortic abnormalities can be investigated with cardiac CT (CPT®75572)if echocardiogram is indeterminate.
Radiation Dose
o Radiation dosage for CCTA varies by facility and the particular protocol used. The American College of Radiology Clinical Statement on Noninvasive Cardiac Imaging states that “as a general rule a multi-detector CT scan encompassing the heart should not result in an effective dose of greater than 12 mSv.”*
o 64-slice CT scanners can deliver a radiation does from 15-25 mSv (especially in women due to breast tissue density).
o Multislice CT is associated with a non-neglible risk for cancer, especially in women and younger patients.* *JAMA 2007; 298:317-323
o Sophisticated gating and other techniques can reduce the radiation dose of cardiac CT studies to less than 5 mSv. Application of these techniques is increasing nationwide.* *J Am Coll Radiol 2005;2:471-477
o Dual source scanners decrease radiation exposure by approximately one third.
o Conventional coronary angiography typically delivers a radiation dose of 3 to 6 mSv.*
*J Am Coll Cardiol 2007;50(15):1469-1475
o Newer imaging technologies will allow for reduced radiation exposure
General
o Certain payers consider coronary calcium scoring and/or cardiac CT and Coronary Computed Tomography Angiography (CCTA) investigational, and their coverage policies will take precedence over MedSolutions' guidelines.
o Most payers require cardiac CT studies to be performed on a 64-slice CT scanner.
o Metal artifact reduces the accuracy of CCTA. Devices that can cause this issue include, but are not limited to, surgical clips, pacemaker devices, defibrillator devices and tissue expanders.
o Cardiac testing that does not involve exposure to ionizing radiation should be strongly considered.
** Multislice CT is associated with a non-neglible risk for cancer, especially in women and younger patients.* *JAMA 2007;298:317-323
o Contraindications to CCTA include:
** Irregular heart rhythms (e.g. atrial fibrillation/flutter, frequent irregular premature ventricular contractions or premature atrial contractions, and high grade heart block)
** Very obese patients (body mass index >40 kg/m2)
** Elevated calcium score
** CCTA should not be performed if there is extensive coronary calcification (calcium score >1000).
** Renal insufficiency
** Inability to follow breath holding instructions
** Heart rate over 75 beats per minute
** Allergy to iodine contrast material
Anomalous Coronary Artery(ies)
o Evaluating coronary artery anomalies and other complex congenital heart disease of cardiac chambers or great vessels is an appropriate indication for CCTA.
** Report CPT®75574 for evaluating coronary artery anomalies
** Report CPT®75573 for congenital heart disease
** Can add CPT®71275 (chest CTA) to evaluate great vessels
** In cases of anomalous pulmonary venous return, can add CT abdomen and pelvis.
The use of CCTA to rule out anomalous coronary artery(ies) should be limited to patients who need to have an anomalous coronary artery mapped prior to an invasive procedure, or who have not had a previous imaging study that clearly demonstrates an anomalous coronary artery and/or shows the anomalous artery to be patent and who are less than age 40 with a history that includes one or more of the following (aortic root echocardiography or cardiac MRI can also be considered to avoid radiation exposure):
** Persistent exertional chest pain and normal stress test
** Full sibling(s) with history of sudden death syndrome before age 30 or with documented anomalous coronary artery
** Resuscitated sudden death and contraindications for conventional coronary angiography
** Unexplained syncope (not presyncope)
** Patients should have had a thorough negative evaluation for syncope as outlined in HD-31 Syncope in the adult Head Imaging Guidelines and PACCD-5 Syncope (e.g. echocardiogram, cardiac evaluation for postural blood pressure changes, resting low blood pressure, or low heart rate, myocardial perfusion imaging study, exercise treadmill test, stress echocardiogram, or stress MRI, consideration for situational syncope) prior to considering CCTA.
** Unexplained new onset of heart failure (e.g. without atherosclerotic coronary artery disease or other known causes for cardiomyopathy) if CCTA will replace conventional invasive coronary angiography.
** Documented ventricular tachycardia (6 beat runs or greater) if CCTA will replace conventional invasive coronary angiography.
** Equivocal coronary artery anatomy on conventional cardiac catheterization
** In infants: otherwise unexplained dyspnea, tachypnea, wheezing, episodic pallor, irritability, sweating, poor feeding, and/or failure to thrive o The presence of other congenital heart disease is not a separate indication for CCTA to rule out anomalous coronary artery(ies).
Other Indications for Cardiac CT/ CCTA:
o Congenital heart disease assessment (with procedures CPT®75573 or CPT®71275) is indicated in both children and adults for the following:
** Determination of extra-cardiac anatomy in patients with complex congenital heart disease
** For example: great vessel relationships, bronchial collateral vessels, abdominal situs, etc.
** Pulmonary artery (PA) and Pulmonary vein assessment:
** Pulmonary artery evaluation in children who need preoperative or postoperative evaluation for PA stenosis or PA atresia
** PA caliber evaluation in children with pulmonary hypoplasia
** PA evaluation to look for another anatomic structure impinging on the PA, or to look for airway/bronchial compromise by an enlarged PA or other mediastinal vessel.
** Assessment of the course of drainage of pulmonary veins when chest x-ray suggests anomalous pulmonary venous drainage.
** Coarctation of the aorta or interruption of the aortic arch suspected on echocardiography.
** Evaluation of the arterial supply and venous drainage in children with bronchopulmonary sequestration.
o Vasculitis/Takayasu's/Kawasaki's disease can be imaged with CCTA (CPT®75574).
o Cardiac CT (CPT®75572) can be used to assess cardiac tumor or mass, pericardial mass, pericarditis/ constrictive pericarditis, complications of cardiac surgery, evaluation of post-operative anatomy and surgically corrected systemic-to-pulmonary artery shunts and intra-cardiac baffles, etc.
o Cardiac CT (CPT®75572) can be used to evaluate cardiac thrombus in patients with technically limited echocardiogram, MRI, or transesophageal echocardiogram.
o Cardiac CT (CPT®75572) can be used to evaluate clinical suspicion of arrhythmogenic right ventricular dysplasia or arrhythmogenic cardiomyopathy (ARVD/ARVC), especially if patient has presyncope or syncope if the clinical suspicion is supported by established criteria for ARVD (see PACCD-3 Evidence Based Clinical Support) or if the patient has documented Brugada’s syndrome.
** If right ventricular abnormalities are already identified by echo or other techniques, cardiac CT may not be necessary.
** Young patients with right bundle branch block, unexplained syncope, and “normal” echo can undergo cardiac MRI (CPT®75557 or CPT®75561) or cardiac CT (CPT®75572) to rule out ARVD/ARVC.
o Native aortic abnormalities can be investigated with cardiac CT (CPT®75572)if echocardiogram is indeterminate.
Radiation Dose
o Radiation dosage for CCTA varies by facility and the particular protocol used. The American College of Radiology Clinical Statement on Noninvasive Cardiac Imaging states that “as a general rule a multi-detector CT scan encompassing the heart should not result in an effective dose of greater than 12 mSv.”*
o 64-slice CT scanners can deliver a radiation does from 15-25 mSv (especially in women due to breast tissue density).
o Multislice CT is associated with a non-neglible risk for cancer, especially in women and younger patients.* *JAMA 2007; 298:317-323
o Sophisticated gating and other techniques can reduce the radiation dose of cardiac CT studies to less than 5 mSv. Application of these techniques is increasing nationwide.* *J Am Coll Radiol 2005;2:471-477
o Dual source scanners decrease radiation exposure by approximately one third.
o Conventional coronary angiography typically delivers a radiation dose of 3 to 6 mSv.*
*J Am Coll Cardiol 2007;50(15):1469-1475
o Newer imaging technologies will allow for reduced radiation exposure
Saturday, August 20, 2016
CARDIAC MRI CPT 75557, 75559,75561 - 75565
CARDIAC MRI
o All requests for cardiac MRI should be sent for Medical Director review.
o MRI may be contraindicated due to metal implants, claustrophobia, BMI >40 kg/m2*
*Am J Cardiol 2009;104:1540-1546
o MRA of the coronary arteries is not yet adequately sophisticated to replace coronary angiography in evaluating coronary disease and should not be authorized.
** EXCEPTIONS: coronary artery anomalies (refer to CD-8.6 Other Indications for CCTA in the adult Cardiac Imaging Guidelines) and Kawasaki disease are conditions where MRA is considered useful.
** MRA of the coronary arteries is reported with CPT®76498, unlisted magnetic resonance procedure (e.g., diagnostic, interventional).
** All requests for unlisted studies should be sent for Medical Director review
** Requests must be accompanied by detailed notes describing the procedure and indications.
o NOTE: Many patients with congenital heart disease are adequately evaluated using echocardiography. Cardiac MRI should be considered if a specific clinical question is left unanswered by another recent cardiac imaging study (usually echo) and the answer to the clinical question will affect management of the patient’s clinical condition.
CODING NOTES: CARDIAC MRI
o 2011 Cardiac MRI CPT® codes:
** CPT®75557 Cardiac MRI for morphology and function without contrast
** CPT®75559 Cardiac MRI for morphology and function without contrast materials; with stress imaging
** CPT®75561 Cardiac MRI for morphology and function without contrast materials, followed by contrast material(s) and further sequences
** CPT®75563 Cardiac MRI for morphology and function without contrast materials, followed by contrast material(s) and further sequences; with stress imaging
** CPT®75565 Cardiac MRI for velocity flow mapping
o The add-on code, CPT® 75565, describes the cardiac MRI blood flow measurement procedure and, when performed, is to be reported in conjunction with CPT®75557, CPT®75559, CPT®75561, or CPT®75563.
o Per the AMA: Only one procedure in the series 75557-75563 is appropriately reported per session and only one flow velocity measurement (CPT® 75565) may be reported per session.*
*
Indications for Cardiac MRI
o Many patients with congenital heart disease are adequately evaluated using echocardiography. Cardiac MRI should be considered if a specific clinical question is left unanswered by another recent cardiac imaging study (usually echo) and the answer to the clinical question will affect management of the patient’s clinical condition.
o Indications for Cardiac MRI in the Congenital Heart Disease and/or Pediatric Population Include:
** Congenital heart disease assessment before and after invasive intervention (e.g. Tetralogy of Fallot, patent ductus arteriosus, platypnea, coarctation of the aorta, atrial septal defects, ventricular septal defects [VSD], pulmonary atresia with VSD, transposition of the great arteries, double outlet right ventricle, heterotaxy syndromes, anomalous pulmonary arteries or veins or anomalous coronary arteries, etc.
** Use one of the following: CPT®75557 or CPT®75561.
** CPT®71555 (chest MRA) may be added if the aorta or pulmonary artery needs to be visualized beyond the root, or if aortopulmonary collaterals, pulmonary veins, or systemic veins need to be visualized.
** Chest MRA alone (CPT®71555) should be performed if the patient cannot cooperate with full cardiac MRI exam.
** Cardiac MRI (CPT®75565 in conjunction with CPT®75557 or CPT®75561) can be used to evaluate for shunting through a VSD if a recent echo has been done, including a bubble study, and there is documented need to perform cardiac MRI in order to resolve an unanswered question.
** Coarctation of the aorta
** Follow-up (surveillance) imaging after repair of coarctation: Adults (age 18 and older): chest MRA (CPT®71555) every 2 to 3 years and before and after any intervention for re-coarctation Infants and children (below 18 years old): echo every month for several months then echo every 6 months to one year thereafter.
** Typical frequency of follow-up imaging for Tetralogy of Fallot is once a year. More frequent imaging may be necessary if clinical symptoms warrant or if imaging is needed following a new interventional procedure.
** Clinical suspicion of arrhythmogenic right ventricular dysplasia or arrhythmogenic cardiomyopathy (ARVD/ARVC), especially if patient has presyncope or syncope if the clinical suspicion is supported by established criteria for ARVD (see PACCD-3 Evidence Based Clinical
Support) or if the patient has documented Brugada’s syndrome. MRI (CPT®75557) is considered the optimal test for this disorder.*
** If right ventricular abnormalities are already identified by echo or other techniques, MRI may not be necessary.
** Young patients with right bundle branch block, unexplained syncope, and “normal” echo can undergo cardiac MRI (CPT®75557 or CPT®75561) to rule out ARVD/ARVC.
* Circulation 2006;113:316-327
*Am J Med 1994;97:78-88
*Eur Heart J 1989;10:127-132
*Circulation 2005;112(25):3823-3832
** Pericardial disease: (constrictive versus restrictive pericarditis; perimyocarditis): Report CPT®75561. MRI should not be utilized to ‘diagnose’ pericarditis but only to answer the question regarding possible constriction or restriction suggested clinically or by other techniques.
** Evaluate cardiac tumor or mass: (e.g. in sarcoidosis or tuberous sclerosis). Report CPT®75561
** Anomalous coronary arteries: Cardiac MRI (CPT®75561) or CCTA (CPT®75574) (which is still favored) is much better at detecting this than conventional angiography
** Fabry's disease: late enhancement MRI may predict the effect of enzyme replacement therapy on myocardial changes that occur with this disease. Report CPT®75561
** Cardiomyopathy
** Cardiac MRI can be performed to evaluate patients with congenital cardiomyopathy (muscular dystrophy, glycogen storage disease, fatty acid oxidation disorders, mitochondrial disorders, etc.)
** Cardiac MRI can be performed in unexplained cases of cardiomyopathy in order to characterize the myocardium.
** Assessment of global ventricular function and mass if a specific clinical question is left unanswered by another recent cardiac imaging study (e.g. echo, etc.) and the answer to the clinical question will affect management of the patient’s clinical condition.
** Cardiac stress perfusion study: can be considered on a case by case basis for patients with anomalous coronary artery, Kawasaki disease, or other disorder with the potential for coronary ischemia.
Saturday, August 6, 2016
Transesophageal Echocardiography (TEE) CODING NOTES
2011 Transesophageal Echo CPT® Codes:
93312 TEE with 2-D, M-mode, probe placement, image acquisition, interpretation and report
93313 TEE probe placement only
93314 TEE image acquisition, interpretation, and report only
93315 TEE for congenital anomalies with 2-D, M-mode, probe placement, image acquisition, interpretation and report
93316 TEE for congenital anomalies, probe placement only
93317 TEE for congenital anomalies, image acquisition, interpretation and report only
93318 TEE for monitoring purposes, ongoing assessment of cardiac pumping function on an immediate time basis
2011 Doppler Echocardiography CPT® Codes:
93320 Doppler echo, pulsed wave and/or spectral display
93321 Doppler echo, pulsed wave and/or spectral display, follow-up or limited study
93325 Doppler echo, color flow velocity mapping
v The Doppler echo codes, if performed, may be reported with TEE codes: 93312, 93314, 93315, and 93317.
For coding purposes, there are two parts to the TEE service:
1. Placement of the transesophageal probe (transducer)
2. Image acquisition, interpretation, and report
The complete transesophageal echocardiogram service, including both probe placement and image acquisition/interpretation, is reported with code 93312.
Probe placement only is reported with code 93313.
The image acquisition/interpretation only is reported with code 93314.
Physicians use codes 93312, 93313, and/or 93314 to report professional services if the test is performed in a hospital or other facility where the physician cannot bill globally.
Modifier -26 (professional component) is appended to the appropriate code
Codes 93313 and 93314 should never be billed together.
v If both services are provided, code 93312 is reported.
Hospitals should report TEE procedures using code 93312 (the complete service).
Codes 93313 and 93314 are not used for hospital billing.
Transesophageal echo is frequently used to monitor patients undergoing cardiac surgery and is reported with code 93318.
o The following are indications for which transesophageal echocardiography (TEE) can be performed at least once:
Limited transthoracic echo window
Detection of embolic source or intracardiac shunting when TTE is inconclusive
Examples: atrial septal defect, ventricular septal defect, patent foramen ovale, aortic cholesterol plaques, thrombus in cardiac chambers, valve vegetations, tumor
Evaluation of embolic events when there is an abnormal TTE, abnormal ECG, and a history of atrial fibrillation
Need to clarify pathology of the atria/atrial appendage, aorta, mitral/aortic valve beyond the information that other imaging studies have provided
Evaluation of cardiac valve dysfunction
Differentiation of tricuspid from bicuspid aortic valve
Congenital abnormalities
o The need for repeat TEE studies is based upon findings in the original study
and documentation of the way in which repeat studies will affect patient management:
o TEE is not particularly sensitive for left ventricular assessment since this chamber lies farther from the TEE probe than in transthoracic echo
Exceptions: the base of the heart in evaluating asymmetric septal hypertrophy or membranous ventricular septal defect
93312 TEE with 2-D, M-mode, probe placement, image acquisition, interpretation and report
93313 TEE probe placement only
93314 TEE image acquisition, interpretation, and report only
93315 TEE for congenital anomalies with 2-D, M-mode, probe placement, image acquisition, interpretation and report
93316 TEE for congenital anomalies, probe placement only
93317 TEE for congenital anomalies, image acquisition, interpretation and report only
93318 TEE for monitoring purposes, ongoing assessment of cardiac pumping function on an immediate time basis
2011 Doppler Echocardiography CPT® Codes:
93320 Doppler echo, pulsed wave and/or spectral display
93321 Doppler echo, pulsed wave and/or spectral display, follow-up or limited study
93325 Doppler echo, color flow velocity mapping
v The Doppler echo codes, if performed, may be reported with TEE codes: 93312, 93314, 93315, and 93317.
For coding purposes, there are two parts to the TEE service:
1. Placement of the transesophageal probe (transducer)
2. Image acquisition, interpretation, and report
The complete transesophageal echocardiogram service, including both probe placement and image acquisition/interpretation, is reported with code 93312.
Probe placement only is reported with code 93313.
The image acquisition/interpretation only is reported with code 93314.
Physicians use codes 93312, 93313, and/or 93314 to report professional services if the test is performed in a hospital or other facility where the physician cannot bill globally.
Modifier -26 (professional component) is appended to the appropriate code
Codes 93313 and 93314 should never be billed together.
v If both services are provided, code 93312 is reported.
Hospitals should report TEE procedures using code 93312 (the complete service).
Codes 93313 and 93314 are not used for hospital billing.
Transesophageal echo is frequently used to monitor patients undergoing cardiac surgery and is reported with code 93318.
o The following are indications for which transesophageal echocardiography (TEE) can be performed at least once:
Limited transthoracic echo window
Detection of embolic source or intracardiac shunting when TTE is inconclusive
Examples: atrial septal defect, ventricular septal defect, patent foramen ovale, aortic cholesterol plaques, thrombus in cardiac chambers, valve vegetations, tumor
Evaluation of embolic events when there is an abnormal TTE, abnormal ECG, and a history of atrial fibrillation
Need to clarify pathology of the atria/atrial appendage, aorta, mitral/aortic valve beyond the information that other imaging studies have provided
Evaluation of cardiac valve dysfunction
Differentiation of tricuspid from bicuspid aortic valve
Congenital abnormalities
o The need for repeat TEE studies is based upon findings in the original study
and documentation of the way in which repeat studies will affect patient management:
o TEE is not particularly sensitive for left ventricular assessment since this chamber lies farther from the TEE probe than in transthoracic echo
Exceptions: the base of the heart in evaluating asymmetric septal hypertrophy or membranous ventricular septal defect
Thursday, July 28, 2016
Transthoracic Echocardiography (TTE) CPT codes and indication
2011 Transthoracic Echo CPT® Codes:
§ CPT®93303 TTE for congenital cardiac anomalies, complete
§ CPT®93304 TTE for congenital cardiac anomalies, follow-up or limited
§ CPT®93306 TTE with 2-D, M-mode, Doppler and color flow, complete
§ CPT®93307 TTE with 2-D, M-mode, without Doppler or color flow
§ CPT®93308 TTE with 2-D, M-mode, follow-up or limited
The following are indications for which transthoracic echocardiography (TTE) can be performed at least once:
Ø Valve function and structure including:
§ Mitral valve prolapse
§ Mitral regurgitation
§ Mitral stenosis
§ Aortic regurgitation
§ Aortic stenosis
§ Bicuspid aortic valve
§ Tricuspid valve regurgitation
§ Pulmonary valve regurgitation
Ø If valve surgery is being considered, TTE to assess aortic, pulmonary or mitral stenosis or regurgitation can be performed once or twice a year.
§ TTE can accurately assess the severity of valve stenosis but is sometimes less accurate in assessing valve regurgitation.
Ø Ventricular function including global and segmental wall motion for evaluating ejection fraction (EF) and coronary artery disease.
§ Echo can be performed to evaluate cardiomyopathy due to etiologies such as ischemia, alcohol, viral myocarditis, or idiopathic.
§ Echo can be performed before and after chemotherapy known to affect heart function.
Ø Ventricular structure including:
§ Infiltrative diseases (e.g. sarcoid, amyloid)
§ Aneurysm with/without thrombus
§ Ventricular septal defect (VSD)
§ Papillary muscle rupture/dysfunction
§ Hypertrophy (including asymmetric septal hypertrophy, spade heart, hypertensive concentric hypertrophy, infiltrative hypertrophy)
Ø Evaluate atrial or ventricular chamber size (e.g. patients with atrial fibrillation, tachyarrhythmias, or left ventricular dilatation).
§ Yearly TTE may be indicated depending on the clinical circumstance.
Ø Detection of embolic source in patients with recent Transient Ischemic
Attack (TIA), stroke, or peripheral vascular emboli.
§ Although transesophageal Echo (TEE) is more accurate in visualizing thrombus in the cardiac chambers and in visualizing the cardiac valves for vegetations (or classic mitral valve fibrinous excrescences), TTE is non-invasive and is indicated as the initial study.
§ Intravenous injected sterile saline contrast can be performed for shunt detection in cases of known or suspected atrial and/or ventricular septal defect and/or patent foramen ovale.
v This is best assessed using TEE, especially in patients with decompression illness, although TTE is still useful in this setting.
Ø Evaluation of ASD repair or VSD repair; within the first year of surgery, if stable clinically, routine imaging is not supported.
§ If patients become newly symptomatic more than one year after successful repair of congenital heart disease, TTE is appropriate
Ø Tumor evaluation including myxomas
Ø Clot detection
Ø Evaluation of right ventricular systolic pressure and pulmonary
hypertension
Ø Evaluation of pericardial effusion/pericardial disease including pericardial cysts
(cysts are usually benign, most frequently at the right cardiophrenic border, treated by observation [chest CT, cardiac MRI, or TTE] or drainage prcutaneously or by open surgery), particularly suspected cardiac tamponade
Ø Evaluation of congenital heart disease
Ø Evaluation of endocarditis
§ TTE or TEE is appropriate when there is fever, positive blood cultures indicating bacteremia, or a new murmur.
v Note: lack of visible vegetations does not eliminate the diagnosis.
v TEE remains a more sensitive technique for identification of small vegetations.
Ø Complications of pacemaker insertion should be monitored by TTE
Ø Coarctation of the Aorta
§ Follow-up (surveillance) imaging after repair of coarctation.
v Infants and children: echo every month for several months, then echo every 6 months to one year thereafter until age 18, then follow surveillance imaging frequency for adults—chest MRA (CPT®71555) every 2 to 3 years and before and after any intervention for re-coarctation.
o Screening for first-degree relatives of patients with hypertrophic
cardiomyopathy (HCM)
Ø First-degree relatives who are 12 to 18 years old should be screened yearly for HCM by 2D- echocardiography and ECG .
Ø First-degree relatives who are older than age 18 should have 2D-echo and
ECG every five years to screen for delayed adult-onset LVH.
Ø Systematic screening is usually not indicated for first-degree relatives who
are younger than age 12 unless there is a high-risk family history or the child is involved in particularly intense competitive sports.
Ø Affected individuals identified through family screening or otherwise should be evaluated every 12 to18 months with 2D-echo, Holter monitor, and blood pressure response during maximal upright exercise.
§ CPT®93303 TTE for congenital cardiac anomalies, complete
§ CPT®93304 TTE for congenital cardiac anomalies, follow-up or limited
§ CPT®93306 TTE with 2-D, M-mode, Doppler and color flow, complete
§ CPT®93307 TTE with 2-D, M-mode, without Doppler or color flow
§ CPT®93308 TTE with 2-D, M-mode, follow-up or limited
The following are indications for which transthoracic echocardiography (TTE) can be performed at least once:
Ø Valve function and structure including:
§ Mitral valve prolapse
§ Mitral regurgitation
§ Mitral stenosis
§ Aortic regurgitation
§ Aortic stenosis
§ Bicuspid aortic valve
§ Tricuspid valve regurgitation
§ Pulmonary valve regurgitation
Ø If valve surgery is being considered, TTE to assess aortic, pulmonary or mitral stenosis or regurgitation can be performed once or twice a year.
§ TTE can accurately assess the severity of valve stenosis but is sometimes less accurate in assessing valve regurgitation.
Ø Ventricular function including global and segmental wall motion for evaluating ejection fraction (EF) and coronary artery disease.
§ Echo can be performed to evaluate cardiomyopathy due to etiologies such as ischemia, alcohol, viral myocarditis, or idiopathic.
§ Echo can be performed before and after chemotherapy known to affect heart function.
Ø Ventricular structure including:
§ Infiltrative diseases (e.g. sarcoid, amyloid)
§ Aneurysm with/without thrombus
§ Ventricular septal defect (VSD)
§ Papillary muscle rupture/dysfunction
§ Hypertrophy (including asymmetric septal hypertrophy, spade heart, hypertensive concentric hypertrophy, infiltrative hypertrophy)
Ø Evaluate atrial or ventricular chamber size (e.g. patients with atrial fibrillation, tachyarrhythmias, or left ventricular dilatation).
§ Yearly TTE may be indicated depending on the clinical circumstance.
Ø Detection of embolic source in patients with recent Transient Ischemic
Attack (TIA), stroke, or peripheral vascular emboli.
§ Although transesophageal Echo (TEE) is more accurate in visualizing thrombus in the cardiac chambers and in visualizing the cardiac valves for vegetations (or classic mitral valve fibrinous excrescences), TTE is non-invasive and is indicated as the initial study.
§ Intravenous injected sterile saline contrast can be performed for shunt detection in cases of known or suspected atrial and/or ventricular septal defect and/or patent foramen ovale.
v This is best assessed using TEE, especially in patients with decompression illness, although TTE is still useful in this setting.
Ø Evaluation of ASD repair or VSD repair; within the first year of surgery, if stable clinically, routine imaging is not supported.
§ If patients become newly symptomatic more than one year after successful repair of congenital heart disease, TTE is appropriate
Ø Tumor evaluation including myxomas
Ø Clot detection
Ø Evaluation of right ventricular systolic pressure and pulmonary
hypertension
Ø Evaluation of pericardial effusion/pericardial disease including pericardial cysts
(cysts are usually benign, most frequently at the right cardiophrenic border, treated by observation [chest CT, cardiac MRI, or TTE] or drainage prcutaneously or by open surgery), particularly suspected cardiac tamponade
Ø Evaluation of congenital heart disease
Ø Evaluation of endocarditis
§ TTE or TEE is appropriate when there is fever, positive blood cultures indicating bacteremia, or a new murmur.
v Note: lack of visible vegetations does not eliminate the diagnosis.
v TEE remains a more sensitive technique for identification of small vegetations.
Ø Complications of pacemaker insertion should be monitored by TTE
Ø Coarctation of the Aorta
§ Follow-up (surveillance) imaging after repair of coarctation.
v Infants and children: echo every month for several months, then echo every 6 months to one year thereafter until age 18, then follow surveillance imaging frequency for adults—chest MRA (CPT®71555) every 2 to 3 years and before and after any intervention for re-coarctation.
o Screening for first-degree relatives of patients with hypertrophic
cardiomyopathy (HCM)
Ø First-degree relatives who are 12 to 18 years old should be screened yearly for HCM by 2D- echocardiography and ECG .
Ø First-degree relatives who are older than age 18 should have 2D-echo and
ECG every five years to screen for delayed adult-onset LVH.
Ø Systematic screening is usually not indicated for first-degree relatives who
are younger than age 12 unless there is a high-risk family history or the child is involved in particularly intense competitive sports.
Ø Affected individuals identified through family screening or otherwise should be evaluated every 12 to18 months with 2D-echo, Holter monitor, and blood pressure response during maximal upright exercise.
Friday, July 15, 2016
Diagnostic arteriography CPT 36200, 36245, 36251, G0278 and 75658 - COVERED ICD code
CPT/HCPCS Codes
Group 1 Codes
36200 Place catheter in aorta
36245 Ins cath abd/l-ext art 1st
36246 Ins cath abd/l-ext art 2nd
36247 Ins cath abd/l-ext art 3rd
36248 Ins cath abd/l-ext art addl
75625 Contrast exam abdominl aorta
75726 Artery x-rays abdomen
Group 2 Codes
36251 Ins cath ren art 1st unilat
36252 Ins cath ren art 1st bilat
36253 Ins cath ren art 2nd+ unilat
36254 Ins cath ren art 2nd+ bilat
Group 3 Codes
G0278 Iliac art angio,cardiac cath
75630 X-ray aorta leg arteries
Group 4 Codes
75658 Artery x-rays arm
75710 Artery x-rays arm/leg
75716 Artery x-rays arms/legs
36120 Establish access to artery
75600 Contrast exam thoracic aorta
75605 Contrast exam thoracic aorta
36200 Place catheter in aorta
36215 Place catheter in artery
36216 Place catheter in artery
36217 Place catheter in artery
36218 Place catheter in artery
36221 Place cath thoracic aorta
36222 Place cath carotid/inom art
36223 Place cath carotid/inom art
36224 Place cath carotd art
36225 Place cath subclavian art
36226 Place cath vertebral art
36227 Place cath xtrnl carotid
36228 Place cath intracranial art
ICD-10 Codes that Support Medical Necessity
For CPT codes 36245, 36246, 36247, 36248, 75625, and 75726
Group 1 Codes
C22.0 Liver cell carcinoma
C22.8 Malignant neoplasm of liver, primary, unspecified as to type
C22.9 Malignant neoplasm of liver, not specified as primary or secondary
C78.7 Secondary malignant neoplasm of liver and intrahepatic bile duct
C7B.02 Secondary carcinoid tumors of liver
I70.211 Atherosclerosis of native arteries of extremities with intermittent claudication, right leg
I70.212 Atherosclerosis of native arteries of extremities with intermittent claudication, left leg
I70.213 Atherosclerosis of native arteries of extremities with intermittent claudication, bilateral legs
I70.221 Atherosclerosis of native arteries of extremities with rest pain, right leg
I70.222 Atherosclerosis of native arteries of extremities with rest pain, left leg
I70.223 Atherosclerosis of native arteries of extremities with rest pain, bilateral legs
I70.231 Atherosclerosis of native arteries of right leg with ulceration of thigh
I70.232 Atherosclerosis of native arteries of right leg with ulceration of calf
I70.233 Atherosclerosis of native arteries of right leg with ulceration of ankle
I70.234 Atherosclerosis of native arteries of right leg with ulceration of heel and midfoot
I70.235 Atherosclerosis of native arteries of right leg with ulceration of other part of foot
I70.241 Atherosclerosis of native arteries of left leg with ulceration of thigh
I70.242 Atherosclerosis of native arteries of left leg with ulceration of calf
I70.243 Atherosclerosis of native arteries of left leg with ulceration of ankle
I70.244 Atherosclerosis of native arteries of left leg with ulceration of heel and midfoot
I70.245 Atherosclerosis of native arteries of left leg with ulceration of other part of foot
I70.261 Atherosclerosis of native arteries of extremities with gangrene, right leg
I70.262 Atherosclerosis of native arteries of extremities with gangrene, left leg
I70.263 Atherosclerosis of native arteries of extremities with gangrene, bilateral legs
I70.291 Other atherosclerosis of native arteries of extremities, right leg
I70.292 Other atherosclerosis of native arteries of extremities, left leg
I70.293 Other atherosclerosis of native arteries of extremities, bilateral legs
I70.411 Atherosclerosis of autologous vein bypass graft(s) of the extremities with intermittent claudication, right leg
I70.412 Atherosclerosis of autologous vein bypass graft(s) of the extremities with intermittent claudication, left leg
I70.413 Atherosclerosis of autologous vein bypass graft(s) of the extremities with intermittent claudication, bilateral legs
I70.421 Atherosclerosis of autologous vein bypass graft(s) of the extremities with rest pain, right leg
I70.422 Atherosclerosis of autologous vein bypass graft(s) of the extremities with rest pain, left leg
I70.423 Atherosclerosis of autologous vein bypass graft(s) of the extremities with rest pain, bilateral legs
I70.431 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of thigh
I70.432 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of calf
I70.433 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of ankle
I70.434 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of heel and midfoot
I70.435 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of other part of foot
I70.441 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of thigh
I70.442 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of calf
I70.443 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of ankle
I70.444 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of heel and midfoot
I70.445 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of other part of foot
I70.461 Atherosclerosis of autologous vein bypass graft(s) of the extremities with gangrene, right leg
I70.462 Atherosclerosis of autologous vein bypass graft(s) of the extremities with gangrene, left leg
I70.463 Atherosclerosis of autologous vein bypass graft(s) of the extremities with gangrene, bilateral legs
I70.491 Other atherosclerosis of autologous vein bypass graft(s) of the extremities, right leg
I70.492 Other atherosclerosis of autologous vein bypass graft(s) of the extremities, left leg
I70.493 Other atherosclerosis of autologous vein bypass graft(s) of the extremities, bilateral legs
I70.511 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with intermittent claudication, right leg
I70.512 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with intermittent claudication, left leg
I70.513 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with intermittent claudication, bilateral legs
I70.521 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with rest pain, right leg
I70.522 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with rest pain, left leg
I70.523 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with rest pain, bilateral legs
I70.531 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of thigh
I70.532 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of calf
I70.533 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of ankle
I70.534 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of heel and midfoot
I70.535 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of other part of foot
I70.541 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of thigh
I70.542 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of calf
I70.543 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of ankle
I70.544 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of heel and midfoot
I70.545 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of other part of foot
I70.561 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with gangrene, right leg
I70.562 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with gangrene, left leg
I70.563 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with gangrene, bilateral legs
I70.591 Other atherosclerosis of nonautologous biological bypass graft(s) of the extremities, right leg
I70.592 Other atherosclerosis of nonautologous biological bypass graft(s) of the extremities, left leg
I70.593 Other atherosclerosis of nonautologous biological bypass graft(s) of the extremities, bilateral legs
I70.611 Atherosclerosis of nonbiological bypass graft(s) of the extremities with intermittent claudication, right leg
I70.612 Atherosclerosis of nonbiological bypass graft(s) of the extremities with intermittent claudication, left leg
I70.613 Atherosclerosis of nonbiological bypass graft(s) of the extremities with intermittent claudication, bilateral legs
I70.621 Atherosclerosis of nonbiological bypass graft(s) of the extremities with rest pain, right leg
I70.622 Atherosclerosis of nonbiological bypass graft(s) of the extremities with rest pain, left leg
I70.623 Atherosclerosis of nonbiological bypass graft(s) of the extremities with rest pain, bilateral legs
I70.631 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of thigh
I70.632 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of calf
I70.633 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of ankle
I70.634 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of heel and midfoot
I70.635 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of other part of foot
I70.641 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of thigh
I70.642 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of calf
I70.643 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of ankle
I70.644 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of heel and midfoot
I70.645 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of other part of foot
I70.661 Atherosclerosis of nonbiological bypass graft(s) of the extremities with gangrene, right leg
I70.662 Atherosclerosis of nonbiological bypass graft(s) of the extremities with gangrene, left leg
I70.663 Atherosclerosis of nonbiological bypass graft(s) of the extremities with gangrene, bilateral legs
I70.691 Other atherosclerosis of nonbiological bypass graft(s) of the extremities, right leg
I70.692 Other atherosclerosis of nonbiological bypass graft(s) of the extremities, left leg
I70.693 Other atherosclerosis of nonbiological bypass graft(s) of the extremities, bilateral legs
I70.711 Atherosclerosis of other type of bypass graft(s) of the extremities with intermittent claudication, right leg
I70.712 Atherosclerosis of other type of bypass graft(s) of the extremities with intermittent claudication, left leg
I70.713 Atherosclerosis of other type of bypass graft(s) of the extremities with intermittent claudication, bilateral legs
I70.721 Atherosclerosis of other type of bypass graft(s) of the extremities with rest pain, right leg
I70.722 Atherosclerosis of other type of bypass graft(s) of the extremities with rest pain, left leg
I70.723 Atherosclerosis of other type of bypass graft(s) of the extremities with rest pain, bilateral legs
I70.731 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of thigh
I70.732 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of calf
I70.733 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of ankle
I70.734 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of heel and midfoot
I70.735 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of other part of foot
I70.741 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of thigh
I70.742 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of calf
I70.743 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of ankle
I70.744 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of heel and midfoot
I70.745 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of other part of foot
I70.761 Atherosclerosis of other type of bypass graft(s) of the extremities with gangrene, right leg
I70.762 Atherosclerosis of other type of bypass graft(s) of the extremities with gangrene, left leg
I70.763 Atherosclerosis of other type of bypass graft(s) of the extremities with gangrene, bilateral legs
I70.791 Other atherosclerosis of other type of bypass graft(s) of the extremities, right leg
I70.792 Other atherosclerosis of other type of bypass graft(s) of the extremities, left leg
I70.793 Other atherosclerosis of other type of bypass graft(s) of the extremities, bilateral legs
I71.4 Abdominal aortic aneurysm, without rupture
I71.6 Thoracoabdominal aortic aneurysm, without rupture
I72.4 Aneurysm of artery of lower extremity
I73.89 Other specified peripheral vascular diseases
I73.9 Peripheral vascular disease, unspecified
I74.09 Other arterial embolism and thrombosis of abdominal aorta
I74.5 Embolism and thrombosis of iliac artery
I77.1 Stricture of artery
I77.4 Celiac artery compression syndrome
I77.811 Abdominal aortic ectasia
I77.812 Thoracoabdominal aortic ectasia
I79.0 Aneurysm of aorta in diseases classified elsewhere
I79.1 Aortitis in diseases classified elsewhere
I79.8 Other disorders of arteries, arterioles and capillaries in diseases classified elsewhere
K55.0 Acute vascular disorders of intestine
K55.21 Angiodysplasia of colon with hemorrhage
K91.61 Intraoperative hemorrhage and hematoma of a digestive system organ or structure complicating a digestive sytem procedure
K91.62 Intraoperative hemorrhage and hematoma of a digestive system organ or structure complicating other procedure
K91.840 Postprocedural hemorrhage and hematoma of a digestive system organ or structure following a digestive system procedure
K91.841 Postprocedural hemorrhage and hematoma of a digestive system organ or structure following other procedure
K92.1 Melena
K92.2 Gastrointestinal hemorrhage, unspecified
Q27.33 Arteriovenous malformation of digestive system vessel
S35.01XA Minor laceration of abdominal aorta, initial encounter
S35.01XD Minor laceration of abdominal aorta, subsequent encounter
S35.01XS Minor laceration of abdominal aorta, sequela
S35.02XA Major laceration of abdominal aorta, initial encounter
S35.02XD Major laceration of abdominal aorta, subsequent encounter
S35.02XS Major laceration of abdominal aorta, sequela
S35.09XA Other injury of abdominal aorta, initial encounter
S35.09XD Other injury of abdominal aorta, subsequent encounter
S35.09XS Other injury of abdominal aorta, sequela
S35.511A Injury of right iliac artery, initial encounter
S35.511D Injury of right iliac artery, subsequent encounter
S35.511S Injury of right iliac artery, sequela
S35.512A Injury of left iliac artery, initial encounter
S35.512D Injury of left iliac artery, subsequent encounter
S35.512S Injury of left iliac artery, sequela
S36.114A Minor laceration of liver, initial encounter
S36.114D Minor laceration of liver, subsequent encounter
S36.114S Minor laceration of liver, sequela
S36.115A Moderate laceration of liver, initial encounter
S36.115D Moderate laceration of liver, subsequent encounter
S36.115S Moderate laceration of liver, sequela
S36.116A Major laceration of liver, initial encounter
S36.116D Major laceration of liver, subsequent encounter
S36.116S Major laceration of liver, sequela
S36.118A Other injury of liver, initial encounter
S36.118D Other injury of liver, subsequent encounter
S36.118S Other injury of liver, sequela
Group 2 Paragraph
For CPT codes 36251, 36252, 36253, and 36254
Group 2 Codes
C64.1 Malignant neoplasm of right kidney, except renal pelvis
C64.2 Malignant neoplasm of left kidney, except renal pelvis
C74.01 Malignant neoplasm of cortex of right adrenal gland
C74.02 Malignant neoplasm of cortex of left adrenal gland
C74.11 Malignant neoplasm of medulla of right adrenal gland
C74.12 Malignant neoplasm of medulla of left adrenal gland
C79.01 Secondary malignant neoplasm of right kidney and renal pelvis
C79.02 Secondary malignant neoplasm of left kidney and renal pelvis
D30.01 Benign neoplasm of right kidney
D30.02 Benign neoplasm of left kidney
D30.11 Benign neoplasm of right renal pelvis
D30.12 Benign neoplasm of left renal pelvis
I10 Essential (primary) hypertension
I12.0 Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease
I12.9 Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
I13.0 Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
I13.10 Hypertensive heart and chronic kidney disease without heart failure, with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
I13.11 Hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease, or end stage renal disease
I13.2 Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease
I15.0 Renovascular hypertension
I15.1 Hypertension secondary to other renal disorders
I70.1 Atherosclerosis of renal artery
I72.2 Aneurysm of renal artery
N26.2 Page kidney
N28.0 Ischemia and infarction of kidney
Q27.1 Congenital renal artery stenosis
Q27.2 Other congenital malformations of renal artery
Q27.34 Arteriovenous malformation of renal vessel
R31.0 Gross hematuria
R31.1 Benign essential microscopic hematuria
R31.2 Other microscopic hematuria
R94.4 Abnormal results of kidney function studies
S35.411A Laceration of right renal artery, initial encounter
S35.411D Laceration of right renal artery, subsequent encounter
S35.411S Laceration of right renal artery, sequela
S35.412A Laceration of left renal artery, initial encounter
S35.412D Laceration of left renal artery, subsequent encounter
S35.412S Laceration of left renal artery, sequela
S35.491A Other specified injury of right renal artery, initial encounter
S35.491D Other specified injury of right renal artery, subsequent encounter
S35.491S Other specified injury of right renal artery, sequela
S35.492A Other specified injury of left renal artery, initial encounter
S35.492D Other specified injury of left renal artery, subsequent encounter
S35.492S Other specified injury of left renal artery, sequela
Group 3 Paragraph
For HCPCS/CPT codes 75630 and G0278
Group 3 Codes
I72.4 Aneurysm of artery of lower extremity
I73.89 Other specified peripheral vascular diseases
I73.9 Peripheral vascular disease, unspecified
S35.511A Injury of right iliac artery, initial encounter
S35.511D Injury of right iliac artery, subsequent encounter
S35.511S Injury of right iliac artery, sequela
S35.512A Injury of left iliac artery, initial encounter
S35.512D Injury of left iliac artery, subsequent encounter
S35.512S Injury of left iliac artery, sequela
Group 1 Codes
36200 Place catheter in aorta
36245 Ins cath abd/l-ext art 1st
36246 Ins cath abd/l-ext art 2nd
36247 Ins cath abd/l-ext art 3rd
36248 Ins cath abd/l-ext art addl
75625 Contrast exam abdominl aorta
75726 Artery x-rays abdomen
Group 2 Codes
36251 Ins cath ren art 1st unilat
36252 Ins cath ren art 1st bilat
36253 Ins cath ren art 2nd+ unilat
36254 Ins cath ren art 2nd+ bilat
Group 3 Codes
G0278 Iliac art angio,cardiac cath
75630 X-ray aorta leg arteries
Group 4 Codes
75658 Artery x-rays arm
75710 Artery x-rays arm/leg
75716 Artery x-rays arms/legs
36120 Establish access to artery
75600 Contrast exam thoracic aorta
75605 Contrast exam thoracic aorta
36200 Place catheter in aorta
36215 Place catheter in artery
36216 Place catheter in artery
36217 Place catheter in artery
36218 Place catheter in artery
36221 Place cath thoracic aorta
36222 Place cath carotid/inom art
36223 Place cath carotid/inom art
36224 Place cath carotd art
36225 Place cath subclavian art
36226 Place cath vertebral art
36227 Place cath xtrnl carotid
36228 Place cath intracranial art
ICD-10 Codes that Support Medical Necessity
For CPT codes 36245, 36246, 36247, 36248, 75625, and 75726
Group 1 Codes
C22.0 Liver cell carcinoma
C22.8 Malignant neoplasm of liver, primary, unspecified as to type
C22.9 Malignant neoplasm of liver, not specified as primary or secondary
C78.7 Secondary malignant neoplasm of liver and intrahepatic bile duct
C7B.02 Secondary carcinoid tumors of liver
I70.211 Atherosclerosis of native arteries of extremities with intermittent claudication, right leg
I70.212 Atherosclerosis of native arteries of extremities with intermittent claudication, left leg
I70.213 Atherosclerosis of native arteries of extremities with intermittent claudication, bilateral legs
I70.221 Atherosclerosis of native arteries of extremities with rest pain, right leg
I70.222 Atherosclerosis of native arteries of extremities with rest pain, left leg
I70.223 Atherosclerosis of native arteries of extremities with rest pain, bilateral legs
I70.231 Atherosclerosis of native arteries of right leg with ulceration of thigh
I70.232 Atherosclerosis of native arteries of right leg with ulceration of calf
I70.233 Atherosclerosis of native arteries of right leg with ulceration of ankle
I70.234 Atherosclerosis of native arteries of right leg with ulceration of heel and midfoot
I70.235 Atherosclerosis of native arteries of right leg with ulceration of other part of foot
I70.241 Atherosclerosis of native arteries of left leg with ulceration of thigh
I70.242 Atherosclerosis of native arteries of left leg with ulceration of calf
I70.243 Atherosclerosis of native arteries of left leg with ulceration of ankle
I70.244 Atherosclerosis of native arteries of left leg with ulceration of heel and midfoot
I70.245 Atherosclerosis of native arteries of left leg with ulceration of other part of foot
I70.261 Atherosclerosis of native arteries of extremities with gangrene, right leg
I70.262 Atherosclerosis of native arteries of extremities with gangrene, left leg
I70.263 Atherosclerosis of native arteries of extremities with gangrene, bilateral legs
I70.291 Other atherosclerosis of native arteries of extremities, right leg
I70.292 Other atherosclerosis of native arteries of extremities, left leg
I70.293 Other atherosclerosis of native arteries of extremities, bilateral legs
I70.411 Atherosclerosis of autologous vein bypass graft(s) of the extremities with intermittent claudication, right leg
I70.412 Atherosclerosis of autologous vein bypass graft(s) of the extremities with intermittent claudication, left leg
I70.413 Atherosclerosis of autologous vein bypass graft(s) of the extremities with intermittent claudication, bilateral legs
I70.421 Atherosclerosis of autologous vein bypass graft(s) of the extremities with rest pain, right leg
I70.422 Atherosclerosis of autologous vein bypass graft(s) of the extremities with rest pain, left leg
I70.423 Atherosclerosis of autologous vein bypass graft(s) of the extremities with rest pain, bilateral legs
I70.431 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of thigh
I70.432 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of calf
I70.433 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of ankle
I70.434 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of heel and midfoot
I70.435 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of other part of foot
I70.441 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of thigh
I70.442 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of calf
I70.443 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of ankle
I70.444 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of heel and midfoot
I70.445 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of other part of foot
I70.461 Atherosclerosis of autologous vein bypass graft(s) of the extremities with gangrene, right leg
I70.462 Atherosclerosis of autologous vein bypass graft(s) of the extremities with gangrene, left leg
I70.463 Atherosclerosis of autologous vein bypass graft(s) of the extremities with gangrene, bilateral legs
I70.491 Other atherosclerosis of autologous vein bypass graft(s) of the extremities, right leg
I70.492 Other atherosclerosis of autologous vein bypass graft(s) of the extremities, left leg
I70.493 Other atherosclerosis of autologous vein bypass graft(s) of the extremities, bilateral legs
I70.511 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with intermittent claudication, right leg
I70.512 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with intermittent claudication, left leg
I70.513 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with intermittent claudication, bilateral legs
I70.521 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with rest pain, right leg
I70.522 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with rest pain, left leg
I70.523 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with rest pain, bilateral legs
I70.531 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of thigh
I70.532 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of calf
I70.533 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of ankle
I70.534 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of heel and midfoot
I70.535 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of other part of foot
I70.541 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of thigh
I70.542 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of calf
I70.543 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of ankle
I70.544 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of heel and midfoot
I70.545 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of other part of foot
I70.561 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with gangrene, right leg
I70.562 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with gangrene, left leg
I70.563 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with gangrene, bilateral legs
I70.591 Other atherosclerosis of nonautologous biological bypass graft(s) of the extremities, right leg
I70.592 Other atherosclerosis of nonautologous biological bypass graft(s) of the extremities, left leg
I70.593 Other atherosclerosis of nonautologous biological bypass graft(s) of the extremities, bilateral legs
I70.611 Atherosclerosis of nonbiological bypass graft(s) of the extremities with intermittent claudication, right leg
I70.612 Atherosclerosis of nonbiological bypass graft(s) of the extremities with intermittent claudication, left leg
I70.613 Atherosclerosis of nonbiological bypass graft(s) of the extremities with intermittent claudication, bilateral legs
I70.621 Atherosclerosis of nonbiological bypass graft(s) of the extremities with rest pain, right leg
I70.622 Atherosclerosis of nonbiological bypass graft(s) of the extremities with rest pain, left leg
I70.623 Atherosclerosis of nonbiological bypass graft(s) of the extremities with rest pain, bilateral legs
I70.631 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of thigh
I70.632 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of calf
I70.633 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of ankle
I70.634 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of heel and midfoot
I70.635 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of other part of foot
I70.641 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of thigh
I70.642 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of calf
I70.643 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of ankle
I70.644 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of heel and midfoot
I70.645 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of other part of foot
I70.661 Atherosclerosis of nonbiological bypass graft(s) of the extremities with gangrene, right leg
I70.662 Atherosclerosis of nonbiological bypass graft(s) of the extremities with gangrene, left leg
I70.663 Atherosclerosis of nonbiological bypass graft(s) of the extremities with gangrene, bilateral legs
I70.691 Other atherosclerosis of nonbiological bypass graft(s) of the extremities, right leg
I70.692 Other atherosclerosis of nonbiological bypass graft(s) of the extremities, left leg
I70.693 Other atherosclerosis of nonbiological bypass graft(s) of the extremities, bilateral legs
I70.711 Atherosclerosis of other type of bypass graft(s) of the extremities with intermittent claudication, right leg
I70.712 Atherosclerosis of other type of bypass graft(s) of the extremities with intermittent claudication, left leg
I70.713 Atherosclerosis of other type of bypass graft(s) of the extremities with intermittent claudication, bilateral legs
I70.721 Atherosclerosis of other type of bypass graft(s) of the extremities with rest pain, right leg
I70.722 Atherosclerosis of other type of bypass graft(s) of the extremities with rest pain, left leg
I70.723 Atherosclerosis of other type of bypass graft(s) of the extremities with rest pain, bilateral legs
I70.731 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of thigh
I70.732 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of calf
I70.733 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of ankle
I70.734 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of heel and midfoot
I70.735 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of other part of foot
I70.741 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of thigh
I70.742 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of calf
I70.743 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of ankle
I70.744 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of heel and midfoot
I70.745 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of other part of foot
I70.761 Atherosclerosis of other type of bypass graft(s) of the extremities with gangrene, right leg
I70.762 Atherosclerosis of other type of bypass graft(s) of the extremities with gangrene, left leg
I70.763 Atherosclerosis of other type of bypass graft(s) of the extremities with gangrene, bilateral legs
I70.791 Other atherosclerosis of other type of bypass graft(s) of the extremities, right leg
I70.792 Other atherosclerosis of other type of bypass graft(s) of the extremities, left leg
I70.793 Other atherosclerosis of other type of bypass graft(s) of the extremities, bilateral legs
I71.4 Abdominal aortic aneurysm, without rupture
I71.6 Thoracoabdominal aortic aneurysm, without rupture
I72.4 Aneurysm of artery of lower extremity
I73.89 Other specified peripheral vascular diseases
I73.9 Peripheral vascular disease, unspecified
I74.09 Other arterial embolism and thrombosis of abdominal aorta
I74.5 Embolism and thrombosis of iliac artery
I77.1 Stricture of artery
I77.4 Celiac artery compression syndrome
I77.811 Abdominal aortic ectasia
I77.812 Thoracoabdominal aortic ectasia
I79.0 Aneurysm of aorta in diseases classified elsewhere
I79.1 Aortitis in diseases classified elsewhere
I79.8 Other disorders of arteries, arterioles and capillaries in diseases classified elsewhere
K55.0 Acute vascular disorders of intestine
K55.21 Angiodysplasia of colon with hemorrhage
K91.61 Intraoperative hemorrhage and hematoma of a digestive system organ or structure complicating a digestive sytem procedure
K91.62 Intraoperative hemorrhage and hematoma of a digestive system organ or structure complicating other procedure
K91.840 Postprocedural hemorrhage and hematoma of a digestive system organ or structure following a digestive system procedure
K91.841 Postprocedural hemorrhage and hematoma of a digestive system organ or structure following other procedure
K92.1 Melena
K92.2 Gastrointestinal hemorrhage, unspecified
Q27.33 Arteriovenous malformation of digestive system vessel
S35.01XA Minor laceration of abdominal aorta, initial encounter
S35.01XD Minor laceration of abdominal aorta, subsequent encounter
S35.01XS Minor laceration of abdominal aorta, sequela
S35.02XA Major laceration of abdominal aorta, initial encounter
S35.02XD Major laceration of abdominal aorta, subsequent encounter
S35.02XS Major laceration of abdominal aorta, sequela
S35.09XA Other injury of abdominal aorta, initial encounter
S35.09XD Other injury of abdominal aorta, subsequent encounter
S35.09XS Other injury of abdominal aorta, sequela
S35.511A Injury of right iliac artery, initial encounter
S35.511D Injury of right iliac artery, subsequent encounter
S35.511S Injury of right iliac artery, sequela
S35.512A Injury of left iliac artery, initial encounter
S35.512D Injury of left iliac artery, subsequent encounter
S35.512S Injury of left iliac artery, sequela
S36.114A Minor laceration of liver, initial encounter
S36.114D Minor laceration of liver, subsequent encounter
S36.114S Minor laceration of liver, sequela
S36.115A Moderate laceration of liver, initial encounter
S36.115D Moderate laceration of liver, subsequent encounter
S36.115S Moderate laceration of liver, sequela
S36.116A Major laceration of liver, initial encounter
S36.116D Major laceration of liver, subsequent encounter
S36.116S Major laceration of liver, sequela
S36.118A Other injury of liver, initial encounter
S36.118D Other injury of liver, subsequent encounter
S36.118S Other injury of liver, sequela
Group 2 Paragraph
For CPT codes 36251, 36252, 36253, and 36254
Group 2 Codes
C64.1 Malignant neoplasm of right kidney, except renal pelvis
C64.2 Malignant neoplasm of left kidney, except renal pelvis
C74.01 Malignant neoplasm of cortex of right adrenal gland
C74.02 Malignant neoplasm of cortex of left adrenal gland
C74.11 Malignant neoplasm of medulla of right adrenal gland
C74.12 Malignant neoplasm of medulla of left adrenal gland
C79.01 Secondary malignant neoplasm of right kidney and renal pelvis
C79.02 Secondary malignant neoplasm of left kidney and renal pelvis
D30.01 Benign neoplasm of right kidney
D30.02 Benign neoplasm of left kidney
D30.11 Benign neoplasm of right renal pelvis
D30.12 Benign neoplasm of left renal pelvis
I10 Essential (primary) hypertension
I12.0 Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease
I12.9 Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
I13.0 Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
I13.10 Hypertensive heart and chronic kidney disease without heart failure, with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
I13.11 Hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease, or end stage renal disease
I13.2 Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease
I15.0 Renovascular hypertension
I15.1 Hypertension secondary to other renal disorders
I70.1 Atherosclerosis of renal artery
I72.2 Aneurysm of renal artery
N26.2 Page kidney
N28.0 Ischemia and infarction of kidney
Q27.1 Congenital renal artery stenosis
Q27.2 Other congenital malformations of renal artery
Q27.34 Arteriovenous malformation of renal vessel
R31.0 Gross hematuria
R31.1 Benign essential microscopic hematuria
R31.2 Other microscopic hematuria
R94.4 Abnormal results of kidney function studies
S35.411A Laceration of right renal artery, initial encounter
S35.411D Laceration of right renal artery, subsequent encounter
S35.411S Laceration of right renal artery, sequela
S35.412A Laceration of left renal artery, initial encounter
S35.412D Laceration of left renal artery, subsequent encounter
S35.412S Laceration of left renal artery, sequela
S35.491A Other specified injury of right renal artery, initial encounter
S35.491D Other specified injury of right renal artery, subsequent encounter
S35.491S Other specified injury of right renal artery, sequela
S35.492A Other specified injury of left renal artery, initial encounter
S35.492D Other specified injury of left renal artery, subsequent encounter
S35.492S Other specified injury of left renal artery, sequela
Group 3 Paragraph
For HCPCS/CPT codes 75630 and G0278
Group 3 Codes
I72.4 Aneurysm of artery of lower extremity
I73.89 Other specified peripheral vascular diseases
I73.9 Peripheral vascular disease, unspecified
S35.511A Injury of right iliac artery, initial encounter
S35.511D Injury of right iliac artery, subsequent encounter
S35.511S Injury of right iliac artery, sequela
S35.512A Injury of left iliac artery, initial encounter
S35.512D Injury of left iliac artery, subsequent encounter
S35.512S Injury of left iliac artery, sequela
Saturday, July 9, 2016
Vascular Stenting CPT codes 37221 - 37235 - covered ICD codes
Coverage Indications, Limitations, and/or Medical Necessity
Vascular stenting of lower extremity arteries performed for clinically significant occlusive vascular disease will be considered medically reasonable and necessary for a patient under any of the following circumstances:
Primary therapy for common iliac artery stenosis and occlusions.
Primary therapy for external iliac artery stenoses and occlusions.
Primary therapy for femoral/popliteal arterial stenosis and occlusions.
Salvage therapy for common and external iliac arteries for a suboptimal or failed result from balloon dilation (e.g., persistent translesional gradient, residual diameter stenosis greater than 50%, or flow-limiting dissection).
Salvage therapy for femoral/popliteal arteries for a suboptimal or failed result from balloon dilation (e.g., persistent translesional gradient, residual diameter stenosis greater than 50%, or flow-limiting dissection).
Salvage therapy for tibial/peroneal arterial lesions for a suboptimal result from ballon dilation.
Limitations
Vascular stenting of lower extremity arteries is considered experimental and investigational for a patient under any of the following circumstances as the effectiveness has not been well established and/or is not recommended, and therefore, will not be considered medically reasonable and necessary:
Primary therapy for tibial/peroneal arterial stenosis and occlusions.
It is the expectation that for the covered indications of this policy, the utilized stent will have Food and Drug Administration (FDA) approval for that indication. ‘Off-label use’ of drug-eluting stents and polytetrafluoroethylene (PTFE)-covered stents are non-covered (given the FDA approved use as well as off-label use of such devices is a subject of on-going clinical trials). For the covered indications, a stent approved by the FDA may be covered for off-label use for which efficacy has been supported in peer-reviewed medical literature, given that there are no FDA-contraindications or warnings which have been demonstrated in this regard and given that its use has been a long standing standard of care (this statement is limited to vascular stents for lower extremity arteries as applied to this LCD).
Revenue Codes
Code Description
0320 Radiology - Diagnostic - General Classification
0320 Radiology - Diagnostic - General Classification
0321 Radiology - Diagnostic - Angiocardiography
0322 Radiology - Diagnostic - Arthrography
0323 Radiology - Diagnostic - Arteriography
0323 Radiology - Diagnostic - Arteriography
0324 Radiology - Diagnostic - Chest X-Ray
0329 Radiology - Diagnostic - Other Radiology - Diagnostic
0329 Radiology - Diagnostic - Other Radiology - Diagnostic
0340 Nuclear Medicine - General Classification
0342 Nuclear Medicine - Therapeutic
0349 Nuclear Medicine - Other Nuclear Medicine
0350 CT Scan - General Classification
0351 CT Scan - Head Scan
0352 CT Scan - Body Scan
0359 CT Scan - CT - Other
0402 Other Imaging Services - Ultrasound
0404 Other Imaging Services - Positron Emission Tomography
0409 Other Imaging Services - Other Imaging Services
0610 Magnetic Resonance Technology (MRT) - General Classification
0614 Magnetic Resonance Technology (MRT) - MRI - Other
0615 Magnetic Resonance Technology (MRT) - MRA - Head and Neck
0616 Magnetic Resonance Technology (MRT) - MRA - Lower Extremities
0618 Magnetic Resonance Technology (MRT) - MRA - Other
0619 Magnetic Resonance Technology (MRT) - Other MRT
CPT/HCPCS Codes
Group 1 Codes
37221 Iliac revasc w/stent
37223 Iliac revasc w/stent add-on
37226 Fem/popl revasc w/stent
37227 Fem/popl revasc stnt & ather
37230 Tib/per revasc w/stent
37231 Tib/per revasc stent & ather
37234 Revsc opn/prq tib/pero stent
37235 Tib/per revasc stnt & ather
ICD-10 Codes that Support Medical Necessity
I70.201 Unspecified atherosclerosis of native arteries of extremities, right leg
I70.202 Unspecified atherosclerosis of native arteries of extremities, left leg
I70.203 Unspecified atherosclerosis of native arteries of extremities, bilateral legs
I70.209 Unspecified atherosclerosis of native arteries of extremities, unspecified extremity
I70.211 Atherosclerosis of native arteries of extremities with intermittent claudication, right leg
I70.212 Atherosclerosis of native arteries of extremities with intermittent claudication, left leg
I70.213 Atherosclerosis of native arteries of extremities with intermittent claudication, bilateral legs
I70.219 Atherosclerosis of native arteries of extremities with intermittent claudication, unspecified extremity
I70.221 Atherosclerosis of native arteries of extremities with rest pain, right leg
I70.222 Atherosclerosis of native arteries of extremities with rest pain, left leg
I70.223 Atherosclerosis of native arteries of extremities with rest pain, bilateral legs
I70.229 Atherosclerosis of native arteries of extremities with rest pain, unspecified extremity
I70.231 Atherosclerosis of native arteries of right leg with ulceration of thigh
I70.232 Atherosclerosis of native arteries of right leg with ulceration of calf
I70.233 Atherosclerosis of native arteries of right leg with ulceration of ankle
I70.234 Atherosclerosis of native arteries of right leg with ulceration of heel and midfoot
I70.235 Atherosclerosis of native arteries of right leg with ulceration of other part of foot
I70.238 Atherosclerosis of native arteries of right leg with ulceration of other part of lower right leg
I70.239 Atherosclerosis of native arteries of right leg with ulceration of unspecified site
I70.241 Atherosclerosis of native arteries of left leg with ulceration of thigh
I70.242 Atherosclerosis of native arteries of left leg with ulceration of calf
I70.243 Atherosclerosis of native arteries of left leg with ulceration of ankle
I70.244 Atherosclerosis of native arteries of left leg with ulceration of heel and midfoot
I70.245 Atherosclerosis of native arteries of left leg with ulceration of other part of foot
I70.248 Atherosclerosis of native arteries of left leg with ulceration of other part of lower left leg
I70.249 Atherosclerosis of native arteries of left leg with ulceration of unspecified site
I70.261 Atherosclerosis of native arteries of extremities with gangrene, right leg
I70.262 Atherosclerosis of native arteries of extremities with gangrene, left leg
I70.263 Atherosclerosis of native arteries of extremities with gangrene, bilateral legs
I70.268 Atherosclerosis of native arteries of extremities with gangrene, other extremity
I70.269 Atherosclerosis of native arteries of extremities with gangrene, unspecified extremity
I73.9 Peripheral vascular disease, unspecified
I74.3 Embolism and thrombosis of arteries of the lower extremities
I74.5 Embolism and thrombosis of iliac artery
I74.8 Embolism and thrombosis of other arteries
I77.1 Stricture of artery
I77.72 Dissection of iliac artery
T81.718A Complication of other artery following a procedure, not elsewhere classified, initial encounter
T81.718D Complication of other artery following a procedure, not elsewhere classified, subsequent encounter
T81.718S Complication of other artery following a procedure, not elsewhere classified, sequela
T81.719A Complication of unspecified artery following a procedure, not elsewhere classified, initial encounter
T81.719D Complication of unspecified artery following a procedure, not elsewhere classified, subsequent encounter
T81.719S Complication of unspecified artery following a procedure, not elsewhere classified, sequela
Vascular stenting of lower extremity arteries performed for clinically significant occlusive vascular disease will be considered medically reasonable and necessary for a patient under any of the following circumstances:
Primary therapy for common iliac artery stenosis and occlusions.
Primary therapy for external iliac artery stenoses and occlusions.
Primary therapy for femoral/popliteal arterial stenosis and occlusions.
Salvage therapy for common and external iliac arteries for a suboptimal or failed result from balloon dilation (e.g., persistent translesional gradient, residual diameter stenosis greater than 50%, or flow-limiting dissection).
Salvage therapy for femoral/popliteal arteries for a suboptimal or failed result from balloon dilation (e.g., persistent translesional gradient, residual diameter stenosis greater than 50%, or flow-limiting dissection).
Salvage therapy for tibial/peroneal arterial lesions for a suboptimal result from ballon dilation.
Limitations
Vascular stenting of lower extremity arteries is considered experimental and investigational for a patient under any of the following circumstances as the effectiveness has not been well established and/or is not recommended, and therefore, will not be considered medically reasonable and necessary:
Primary therapy for tibial/peroneal arterial stenosis and occlusions.
It is the expectation that for the covered indications of this policy, the utilized stent will have Food and Drug Administration (FDA) approval for that indication. ‘Off-label use’ of drug-eluting stents and polytetrafluoroethylene (PTFE)-covered stents are non-covered (given the FDA approved use as well as off-label use of such devices is a subject of on-going clinical trials). For the covered indications, a stent approved by the FDA may be covered for off-label use for which efficacy has been supported in peer-reviewed medical literature, given that there are no FDA-contraindications or warnings which have been demonstrated in this regard and given that its use has been a long standing standard of care (this statement is limited to vascular stents for lower extremity arteries as applied to this LCD).
Revenue Codes
Code Description
0320 Radiology - Diagnostic - General Classification
0320 Radiology - Diagnostic - General Classification
0321 Radiology - Diagnostic - Angiocardiography
0322 Radiology - Diagnostic - Arthrography
0323 Radiology - Diagnostic - Arteriography
0323 Radiology - Diagnostic - Arteriography
0324 Radiology - Diagnostic - Chest X-Ray
0329 Radiology - Diagnostic - Other Radiology - Diagnostic
0329 Radiology - Diagnostic - Other Radiology - Diagnostic
0340 Nuclear Medicine - General Classification
0342 Nuclear Medicine - Therapeutic
0349 Nuclear Medicine - Other Nuclear Medicine
0350 CT Scan - General Classification
0351 CT Scan - Head Scan
0352 CT Scan - Body Scan
0359 CT Scan - CT - Other
0402 Other Imaging Services - Ultrasound
0404 Other Imaging Services - Positron Emission Tomography
0409 Other Imaging Services - Other Imaging Services
0610 Magnetic Resonance Technology (MRT) - General Classification
0614 Magnetic Resonance Technology (MRT) - MRI - Other
0615 Magnetic Resonance Technology (MRT) - MRA - Head and Neck
0616 Magnetic Resonance Technology (MRT) - MRA - Lower Extremities
0618 Magnetic Resonance Technology (MRT) - MRA - Other
0619 Magnetic Resonance Technology (MRT) - Other MRT
CPT/HCPCS Codes
Group 1 Codes
37221 Iliac revasc w/stent
37223 Iliac revasc w/stent add-on
37226 Fem/popl revasc w/stent
37227 Fem/popl revasc stnt & ather
37230 Tib/per revasc w/stent
37231 Tib/per revasc stent & ather
37234 Revsc opn/prq tib/pero stent
37235 Tib/per revasc stnt & ather
ICD-10 Codes that Support Medical Necessity
I70.201 Unspecified atherosclerosis of native arteries of extremities, right leg
I70.202 Unspecified atherosclerosis of native arteries of extremities, left leg
I70.203 Unspecified atherosclerosis of native arteries of extremities, bilateral legs
I70.209 Unspecified atherosclerosis of native arteries of extremities, unspecified extremity
I70.211 Atherosclerosis of native arteries of extremities with intermittent claudication, right leg
I70.212 Atherosclerosis of native arteries of extremities with intermittent claudication, left leg
I70.213 Atherosclerosis of native arteries of extremities with intermittent claudication, bilateral legs
I70.219 Atherosclerosis of native arteries of extremities with intermittent claudication, unspecified extremity
I70.221 Atherosclerosis of native arteries of extremities with rest pain, right leg
I70.222 Atherosclerosis of native arteries of extremities with rest pain, left leg
I70.223 Atherosclerosis of native arteries of extremities with rest pain, bilateral legs
I70.229 Atherosclerosis of native arteries of extremities with rest pain, unspecified extremity
I70.231 Atherosclerosis of native arteries of right leg with ulceration of thigh
I70.232 Atherosclerosis of native arteries of right leg with ulceration of calf
I70.233 Atherosclerosis of native arteries of right leg with ulceration of ankle
I70.234 Atherosclerosis of native arteries of right leg with ulceration of heel and midfoot
I70.235 Atherosclerosis of native arteries of right leg with ulceration of other part of foot
I70.238 Atherosclerosis of native arteries of right leg with ulceration of other part of lower right leg
I70.239 Atherosclerosis of native arteries of right leg with ulceration of unspecified site
I70.241 Atherosclerosis of native arteries of left leg with ulceration of thigh
I70.242 Atherosclerosis of native arteries of left leg with ulceration of calf
I70.243 Atherosclerosis of native arteries of left leg with ulceration of ankle
I70.244 Atherosclerosis of native arteries of left leg with ulceration of heel and midfoot
I70.245 Atherosclerosis of native arteries of left leg with ulceration of other part of foot
I70.248 Atherosclerosis of native arteries of left leg with ulceration of other part of lower left leg
I70.249 Atherosclerosis of native arteries of left leg with ulceration of unspecified site
I70.261 Atherosclerosis of native arteries of extremities with gangrene, right leg
I70.262 Atherosclerosis of native arteries of extremities with gangrene, left leg
I70.263 Atherosclerosis of native arteries of extremities with gangrene, bilateral legs
I70.268 Atherosclerosis of native arteries of extremities with gangrene, other extremity
I70.269 Atherosclerosis of native arteries of extremities with gangrene, unspecified extremity
I73.9 Peripheral vascular disease, unspecified
I74.3 Embolism and thrombosis of arteries of the lower extremities
I74.5 Embolism and thrombosis of iliac artery
I74.8 Embolism and thrombosis of other arteries
I77.1 Stricture of artery
I77.72 Dissection of iliac artery
T81.718A Complication of other artery following a procedure, not elsewhere classified, initial encounter
T81.718D Complication of other artery following a procedure, not elsewhere classified, subsequent encounter
T81.718S Complication of other artery following a procedure, not elsewhere classified, sequela
T81.719A Complication of unspecified artery following a procedure, not elsewhere classified, initial encounter
T81.719D Complication of unspecified artery following a procedure, not elsewhere classified, subsequent encounter
T81.719S Complication of unspecified artery following a procedure, not elsewhere classified, sequela
Wednesday, July 6, 2016
Head and Neck Angiography CPT codes
Head and neck diagnostic catheterization and angiography procedures were restructured in 2013:
• Codes are all-inclusive, describing both catheter placement and imaging in a single code.
• Codes are cumulative – all less selective catheter placement and imaging is bundled into more selective. The code descriptors “stair step,” and specific catheter location and extent of imaging (including distal runoff) are both identified.
• All codes include angiography of the cervicocerebral arch, when performed.
• All codes are unilateral – report bilateral with modifier -50. If left and right sides not to same level of selectivity, report lesser code with modifier -59.
• Add-on codes exist for selective catheterizations of external carotid or additional intracranial branches of the internal carotid or vertebral circulatory systems.
Code Catheter Location Vessel(s) imaged
36221 Non-selective, thoracic aorta Extracranial carotid, vertebral, and/or intracranial vessels, unilateral or bilateral
36222 Common carotid or innominate Ipsilateral extracranial carotid
36223 Common carotid or innominate Ipsilateral intracranial carotid, includes extracranial carotid, when performed
36224 Internal carotid Ipsilateral intracranial carotid, includes extracranial carotid, when performed
36225 Subclavian or innominate Ipsilateral vertebral circulation
36226 Vertebral artery Ipsilateral vertebral circulation
+36227 External carotid Ipsilateral external carotid circulation
+36228 Each intracranial branch of the internal carotid or vertebral arteries (eg, middle cerebral artery, posterior inferior cerebellar artery) Selected vessel circulation
Note: Codes 33221 - 33226 include angiography of the cervicocerebral arch, when performed; add-on codes 36227 and 36228 do not, as it would have been captured in a base code.
Thursday, June 30, 2016
Dual pacemaker CPT 33208 , 33227 - Covered ICD code
Initial dual chamber pacemaker system implantation
33208 Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial and ventricular
Possible Hospital Inpatient ICD-10-PCS Codes
02H64JZ Insertion of Pacemaker Lead into Right Atrium, Percutaneous Endoscopic Approach
02H63JZ Insertion of Pacemaker Lead into Right Atrium, Percutaneous Approach
02HK4JZ Insertion of Pacemaker Lead into Right Ventricle, Percutaneous Endoscopic Approach
02HK3JZ Insertion of Pacemaker Lead into Right Ventricle, Percutaneous Approach
0JH606Z Insertion of Pacemaker, Dual Chamber into Chest Subcutaneous Tissue and Fascia, Open Approach
0JH636Z Insertion of Pacemaker, Dual Chamber into Chest Subcutaneous Tissue and Fascia, Percutaneous Approach
0JH806Z Insertion of Pacemaker, Dual Chamber into Abdomen Subcutaneous Tissue and Fascia, Open Approach
0JH836Z Insertion of Pacemaker, Dual Chamber into Abdomen Subcutaneous Tissue and Fascia, Percutaneous Approach
Initial dual chamber pacemaker insertion with external cardioversion performed prior to device implant session for treatment of patient in atrial fibrillation
33208 Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial and ventricular
92960-59,
Possible Hospital Inpatient ICD-10-PCS Codes
0JH606Z Insertion of Pacemaker, Dual Chamber into Chest Subcutaneous Tissue and Fascia, Open Approach
0JH636Z Insertion of Pacemaker, Dual Chamber into Chest Subcutaneous Tissue and Fascia, Percutaneous Approach
0JH806Z Insertion of Pacemaker, Dual Chamber into Abdomen Subcutaneous Tissue and Fascia, Open Approach
0JH836Z Insertion of Pacemaker, Dual Chamber into Abdomen Subcutaneous Tissue and Fascia, Percutaneous Approach
02H64JZ Insertion of Pacemaker Lead into Right Atrium, Percutaneous Endoscopic Approach
02H63JZ Insertion of Pacemaker Lead into Right Atrium, Percutaneous Approach
02HK4JZ Insertion of Pacemaker Lead into Right Ventricle, Percutaneous Endoscopic Approach
02HK3JZ Insertion of Pacemaker Lead into Right Ventricle, Percutaneous Approach
5A2204Z Restoration of Cardiac Rhythm
33227 Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; single lead system
Possible Hospital Inpatient ICD-10-PCS Codes
0JH605Z Insertion of Pacemaker, Single Chamber Rate Responsive into Chest Subcutaneous Tissue and Fascia, Open Approach
0JH635Z Insertion of Pacemaker, Single Chamber Rate Responsive into Chest Subcutaneous Tissue and Fascia, Percutaneous Approach
0JH805Z Insertion of Pacemaker, Single Chamber Rate Responsive into Abdomen Subcutaneous Tissue and Fascia, Open Approach
0JH835Z Insertion of Pacemaker, Single Chamber Rate Responsive into Abdomen Subcutaneous Tissue and Fascia,
Percutaneous Approach
0JPT0PZ Removal of Cardiac Rhythm Related Device from Trunk Subcutaneous Tissue and Fascia, Open Approach
0JPT3PZ Removal of Cardiac Rhythm Related Device from Trunk Subcutaneous Tissue and Fascia, Percutaneous Approach
Monday, June 27, 2016
CPT CODE 33206 , 33207 & 33227 - COVERED ICD code
Initial single chamber rate-responsive pacemaker system implant with right atrial lead
33206 Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial
Possible Hospital Inpatient ICD-10-PCS Codes3
02H64JZ Insertion of Pacemaker Lead into Right Atrium, Percutaneous Endoscopic Approach
02H63JZ Insertion of Pacemaker Lead into Right Atrium, Percutaneous Approach
0JH605Z Insertion of Pacemaker, Single Chamber Rate Responsive into Chest Subcutaneous Tissue and Fascia, Open Approach
0JH635Z Insertion of Pacemaker, Single Chamber Rate Responsive into Chest Subcutaneous Tissue and Fascia, Percutaneous Approach
0JH805Z Insertion of Pacemaker, Single Chamber Rate Responsive into Abdomen Subcutaneous Tissue and Fascia, Open Approach
0JH835Z Insertion of Pacemaker, Single Chamber Rate Responsive into Abdomen Subcutaneous Tissue and Fascia, Percutaneous Approach
Initial single chamber rate-responsive pacemaker system implant with right ventricular lead
33207 Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); ventricular
Possible Hospital Inpatient ICD-10-PCS Codes
02HK3JZ Insertion of Pacemaker Lead into Right Ventricle, Percutaneous Approach
02HK4JZ Insertion of Pacemaker Lead into Right Ventricle, Percutaneous Endoscopic Approach
0JH605Z Insertion of Pacemaker, Single Chamber Rate Responsive into Chest Subcutaneous Tissue and Fascia, Open Approach
0JH635Z Insertion of Pacemaker, Single Chamber Rate Responsive into Chest Subcutaneous Tissue and Fascia, Percutaneous Approach
0JH805Z Insertion of Pacemaker, Single Chamber Rate Responsive into Abdomen Subcutaneous Tissue and Fascia, Open Approach
0JH835Z Insertion of Pacemaker, Single Chamber Rate Responsive into Abdomen Subcutaneous Tissue and Fascia, Percutaneous Approach
Replacement of single chamber rate-responsive pulse generator
33227 Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; single lead system
Possible Hospital Inpatient ICD-10-PCS Codes3
0JH605Z Insertion of Pacemaker, Single Chamber Rate Responsive into Chest Subcutaneous Tissue and Fascia, Open Approach
0JH635Z Insertion of Pacemaker, Single Chamber Rate Responsive into Chest Subcutaneous Tissue and Fascia, Percutaneous Approach
0JH805Z Insertion of Pacemaker, Single Chamber Rate Responsive into Abdomen Subcutaneous Tissue and Fascia, Open Approach
0JH835Z Insertion of Pacemaker, Single Chamber Rate Responsive into Abdomen Subcutaneous Tissue and Fascia,
Tuesday, June 7, 2016
Main CPT CODE list for Cardiology, Pediatric Cardiology and Interventional cardiology
Cardiology (Includes Cardiothoracic Surgery and Cardiovascular Disease)
Focus on chest x-ray, nuclear cardiology, echocardiology, and x-ray incidental to injections or biopsies
71010, 71020, 71021, 71022, 71030, 76930**, 78414, 78428, 78460, 78461, 78464, 78465,
78466, 78468, 78469, 78472, 78473, 78478, 78480, 78481, 78483, 78494, 78496, 78890,
78891, 78990
Pediatric Cardiology
71010, 71020, 71030, 76825, 76826, 76827, 76828 Plain films and x-ray incidental to injections and/or biopsy
Interventional Cardiology
71090, 75625, 75630, 75650, 75658, 75660, 75662, 75665, 75671, 75676, 75680, 75685,
75710, 75716, 75722, 75724, 75726, 75756, 75774, 75896, 75898, 75960, 75962, 75964,
75966, 75968
Peripheral vascular x-rays
Focus on chest x-ray, nuclear cardiology, echocardiology, and x-ray incidental to injections or biopsies
71010, 71020, 71021, 71022, 71030, 76930**, 78414, 78428, 78460, 78461, 78464, 78465,
78466, 78468, 78469, 78472, 78473, 78478, 78480, 78481, 78483, 78494, 78496, 78890,
78891, 78990
Pediatric Cardiology
71010, 71020, 71030, 76825, 76826, 76827, 76828 Plain films and x-ray incidental to injections and/or biopsy
Interventional Cardiology
71090, 75625, 75630, 75650, 75658, 75660, 75662, 75665, 75671, 75676, 75680, 75685,
75710, 75716, 75722, 75724, 75726, 75756, 75774, 75896, 75898, 75960, 75962, 75964,
75966, 75968
Peripheral vascular x-rays
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