Cardiology Coding Alert

Question: Should I use arterial disease codes 443.9, 440.21, 440.1, and 447.3 for venous studies as well? If not, which codes should I use?

Maryland Subscriber

Answer: ICD-9 codes 443.9 (PVD/claudication), 440.21 (Atherosclerosis of the extremities with intermittent claudication), 440.1 (Atherosclerosis; of renal artery), and 447.3 (Fibromuscular dysplasia of renal artery) are probably inappropriate for diagnostic extremity venous studies, such as 93965 (Noninvasive physiologic studies of extremity veins, complete bilateral study), depending on your intermediary's policies.

Why? These diagnoses specify a problem with the arterial system. If your cardiologist performs venous studies, then you should have a diagnosis indicating a venous system symptom or a definitive diagnosis specific to the venous rather than arterial system.

For instance, TrailBlazer's local coverage determination for 93965 specifies two major categories of venous study indications: deep vein thrombosis and chronic venous insufficiency. To properly report 93965, you would use codes from the category for diseases of veins and lymphatics and other diseases of the circulatory system (451-459), according to the LCD. These codes include phlebitis and thrombophlebitis of vessels, varicose veins, and venous hypertension.

Some indications for billing 93965 include symptoms of edema, swelling in a limb, pain in a limb, gangrene, and ulcers of the lower limb. Injury to blood vessels, the 900-904 category, may also be an indication for this diagnostic procedure. Ask your Medicare intermediary for specific guidelines for assigning appropriate diagnoses to demonstrate medical necessity.

-- You Be the Coder and Reader Questions prepared with the assistance of Jim Collins, ACS-CA, CHCC, CPC-CARDIO, president of the Cardiology Coalition and compliance manager for several cardiology groups around the country.