Radiology Coding Alert

Question: Our practice's superbill includes the following ICD-9 Codes for arterial studies. Should I use these codes for venous studies as well? If not, which codes should I use?

443.9 - PVD/claudication

440.21 - Atherosclerosis of the extremities with intermittent claudication

440.1 - Atherosclerosis; of renal artery

447.3 - Fibromuscular dysplasia of renal artery.

New York Subscriber

Answer: The ICD-9 codes you list for arterial studies are most likely not appropriate for diagnostic extremity venous studies, such as 93965 (Non-invasive physiologic studies of extremity veins ...). For instance, Empire Medicare's local medical review policy for 93965 specifies two major categories of venous study indications: deep vein thrombosis and chronic venous insufficiency. The policy does not include any of the diagnoses you indicated.

Symptoms of edema, swelling in the limb, pain in the limb, gangrene and venous stasis ulcers of the lower limb may also be indications for billing 93965. Injury to blood vessels, the 900-904 category, may also be indications for this diagnostic procedure. Your choice of diagnostic codes should be based on the patient's signs, symptoms, and pertinent history as well as the final interpretation of the study itself - not a list of theoretical codes from a superbill. Therefore, even if you tailor the superbill to contain the most likely codes that would engender such a study, you should still allow for other codes to be entered as appropriate to the particular patient.

Ask your Medicare carrier for specific diagnoses that demonstrate medical necessity, but for compliance purposes remember to assign codes based only on the documented indications in the patient's medical record.