Radiology Coding Alert

Question: I saw a notice that our LCD for Noninvasive Vascular Testing (L31712) was revised. How has it changed?

North Carolina Subscriber

Answer: The Palmetto GBA local coverage determination (LCD) you refer to has had multiple revisions since September 2011. Two add ICD-9 codes supporting coverage for a variety of services, while another revision takes CPT® 2012 changes into account.

Effective for dates of service on or after Sept. 1, 2011, the LCD added multiple diagnosis codes supporting noninvasive vascular testing. The LCD pairs specific ICD-9 codes with specific CPT® codes.

For example: The revision adds codes 454.8 (Varicose veins of lower extremities with other complications) and 586 (Renal failure unspecified) to the list of ICD-9 codes supporting these procedure codes:

• 93965, Noninvasive physiologic studies of extremity veins, complete bilateral study (e.g., Doppler waveform analysis with responses to compression and other maneuvers, phleborheography, impedance plethysmography)
• 93970, Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study
• 93971, Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study.

Another revision, effective for services on or after Nov. 15, 2011, expands the list a bit more by adding 368.10 (Subjective visual disturbance unspecified) to the list of codes that support medical necessity for "Cerebrovascular Arterial Studies codes 93880-93882, 93931."

For dates of service on or after Jan. 1, 2012, the LCD removes all references to now deleted code 93875 (Noninvasive physiologic studies of extracranial arteries, complete bilateral study [e.g., periorbital flow direction with arterial compression, ocular pneumoplethysmography, doppler ultrasound spectral analysis]).

You can search for the LCD by entering L31712 in the Quick Search box at www.cms.gov/medicare-coverage- database/ and clicking "Search by ID." On the next page, enter the relevant date of service and click "Search." The search results will then appear.

Helpful: Revisions can be hard to pinpoint, but you should see a list of revisions at the end of the LCD. The list shows a history of the revisions that have taken place over the years so you can identify what changed for each version.