Cardiology Coding Alert
Avoid Arterial Codes for Venous Studies
443.9 PVD/claudication
440.21 Atherosclerosis of the extremities with
intermittent claudication
440.1 Atherosclerosis of renal artery
447.3 Fibromuscular dysplasia of renal artery.
Maryland Subscriber
Answer: The ICD-9 codes you list for arterial studies may not be appropriate for diagnostic extremity venous studies, such as 93965 (Non-invasive physiologic studies of extremity veins ...). For instance, Trailblazer's local medical review policy for 93965 specifies two major categories of venous study indications: deep vein thrombosis and chronic venous insufficiency. To properly report 93965, according to the LMRP, you would use codes from the category for diseases of veins and lymphatics and other diseases of the circulatory system (451-459). These codes include phlebitis and thrombophlebitis of vessels, varicose veins and venous hypertension.
Symptoms of edema, swelling in limb, pain in limb, gangrene and ulcers of the lower limb may also be indications for billing 93965. Injury to blood vessels, the 900-904 category, may also indicate this diagnostic procedure. Ask your Medicare carrier for specific guidelines for assigning appropriate diagnoses to demonstrate medical necessity.
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