Radiology Coding Alert

"Increased reliance on diagnostic ultrasounds of the extremities has placed demands on codersto recognize appropriate diagnosis codes supporting specific ultrasound studies, to be familiar with the various technologies (Doppler vs. duplex) used during these procedures and to better understand the vascular system. Without a clear understanding of these three elementsand their interrelationshipcoders risk miscoding claims and ultimately dealing with payer denials.

Specific Diagnosis Codes Support Arterial, Venous Studies

Noninvasive extremity diagnostic studies, like interventional vascular procedures, are broken into two categories: arterial and venous. Specific diagnosis (ICD-9 ) codes and related service (CPT ) codes correspond with these two physiological systems.

Commonly covered ICD-9 codes used with arterial studies include the 440-series (atherosclerosis), the 441-series (aortic aneurysm and dissection), the 443-series (other peripheral vascular disease), 447.1 (stricture of artery) and 447.2 (rupture of artery).

ICD-9 Codes used with venous studies include the 451-series (phlebitis and thrombophlebitis), 454.0 (varicose veins of lower extremities; with ulcer) and 454.2 (varicose veins of lower extremities; with ulcer and inflammation), and 671.20-671.24 (superficial thrombophlebitis associated with pregnancy and the puerperium).

Several diagnosis codes describe general vascular conditions that can be used to support either arterial or venous ultrasound studies. They include the 903-series (injury to blood vessels of upper extremity) and the 904-series (injury to blood vessels of lower extremity and unspecified sites).

Editors note: See the insert included with this issue of Radiology Coding Alert for a complete listing of diagnosis codes and the procedure codes with which they correspond. Coders will want to keep this guide at their fingertips as an easy reference guide.

Misuse of Diagnosis Coding Increases Rate of Denials

Ultrasound studies of the extremities are usually ordered when a physician suspects that something is interfering with blood flow, explains Richard Brebner, BS, RDMS, RDCS, RVT, vice president and technical director for Ultrasound Services Inc., which provides diagnostic ultrasound services to practices in Pennsylvania, Delaware and New Jersey. The physician will have a good sense of whether the problem lies in the arterial or venous system, based on the patients symptoms.

The arterial system moves blood away from the heart to the organs and extremities, Brebner says, providing nourishment and oxygen. Signs that might indicate an arterial problem include decreased pulses, a bluish cast to the extremitiesfingers or toes, for instanceand skin that is cold to the touch. That would indicate that the blood is not reaching these areas because of arterial insufficiency. He adds that many diabetic patients who suffer from arterial circulation problems exhibit these symptoms.

On the other hand, Brebner points out, the venous system transports the blood back to the heart. If an occlusion or blood clot occurs in a vein, blood pools and causes swelling [...]