Radiology Coding Alert

Distinguishing between the arterial and venous systems lies at the heart of correctly coding noninvasive vascular studies of the extremities, including ultrasounds. The differences between the symptoms and conditions requiring ultrasounds of the two systems are dramatic, and CPT Codes provides distinct codes to describe the studies that provide definitive diagnostic information for each.
Initial Symptoms Reveal Study Type
"The arterial system performs a much different function than the venous system," says Richard Brebner, BS, RDMS, RDCS, RVT, vice president and technical director for Ultrasound Services Inc., which provides diagnostic ultrasound services in Penn-sylvania, Delaware and New Jersey. "Arteries move blood away from the heart to the extremities, while the veins return the blood from the extremities back to the heart." Because these functions are so different, interference with blood flow in one system will produce much different symptoms from interference in the other. These disparities, which will be outlined in the medical record, can help coders immediately determine whether they should consider arterial or venous ultrasound codes. (See table on page 19.)
 
Signs that indicate blood is not reaching the extremities because of arterial insufficiency include decreased pulses, a bluish cast to the skin on the fingers or toes, for instance and skin that is cold to the touch. When coders see these symptoms in the physician documentation, they should immediately turn to codes describing arterial ultrasounds (93922-93930). However, if an occlusion or blood clot occurs in a vein, blood pools, causing swelling and redness. The skin becomes warm to the touch. Radiologist documentation of these indications should cause coders to consider venous ultrasound codes (93965-93971).
 
Note: In some cases, severe venous occlusion may also compromise the arterial inflow. When this clinical condition, called phlegmasia cerulea albicans, is suspected, a venous study may be performed instead of or in addition to the arterial study.
Study Type Drives Diagnosis Coding
Because the symptoms indicate problems in either the arterial or venous system, diagnosis coding is equally unequivocal, says Pat Kirkham, RDMS, sonographer with Randallwood Radiology, a private practice of three radiologists in St. Charles, Ill. "There are specific diagnoses that relate to conditions of the arteries and others that relate only to the veins," Kirkham says. Coders must be sure to match the correct symptoms with the correct diagnosis code. These must tie in with the study performed or the claim will certainly be denied, Kirkham adds.
 
The arterial diagnoses codes for circulation problems interfering with blood getting to the extremities include:

  440.x series Atherosclerosis
  441.x series Aortic aneurysm and dissection
  443.x [...]