Cardiology Coding Alert

Question: My department is interested in doing carotid intimal medial thickness measurements to assess cardiovascular risk in patients who might have atherosclerosis. This would be a limited carotid exam. How can we effectively bill for these limited carotid studies, including diagnosis codes and procedures?

Michigan Subscriber

Answer: Medicare and private carriers may not cover carotid intimal medial thickness studies to assess cardiovascular risk because cardiologists generally use the procedure as a screening method.

Moreover, 93882 (Duplex scan of extracranial arteries; unilateral or limited study) probably would not be appropriate if the service being provided is a carotid Doppler without vascular flow analysis. The rationale behind this is that, according to CPT 2002, using a "Doppler device that does not produce hard-copy output or that produces a record that does not permit analysis of bi-directional vascular flow is considered to be part of the physical examination of the vascular system and is not separately reported."

Given the lack of specific Medicare or CPT codes for this service, you would be well advised not to report the procedure for reimbursement, but you may be able to bill an E/M code to cover the services provided. However, there is plenty of research that establishes a link between this individual measurement and the likelihood of future vascular problems.

- Answers for You Be the Coder and Reader Questions were provided by Nikki Vendegna, CPC, a cardiology coding and reimbursement specialist in Overland Park, Kan.; Marko Yakovlevitch, MD, FACP, FACC, a cardiologist in private practice in Seattle; Lisa Clifford, CPC, owner of the multispecialty coding firm Clifford Medical Billing Specialists Inc. in Naples, Fla.; Jim Collins, CHCC, CPC, a coding consultant and compliance officer with Mid-Carolina Cardiology in Matthews, N.C.; Sandy Fuller, CPC, a cardiology coding and reimbursement specialist in Abilene, Texas; and Sheldrian Wayne, CPC, a cardiology coding specialist with Atlanta-based Coding Strategies Inc.