To perform a duplex scanning sweep is needed in real time, therefore the billing of a duplex scanning and ultrasound (Doppler) of the same body part represents «unbundling» and not appropriate as ageneral practice or standing protocol ,and therefore would not be expected.
The complete physiological study of an extremity includes measures pressure and other physiological studies (eg. Doppler). Duplex scanning and physiological studies are considered for payment during the same visit only under the following conditions:
· If abnormal physiological studies.
· In the evaluation of vascular trauma.
· The evaluation of thromboembolic events.
· The evaluation of aneurysmal disease
Noninvasive physiological studies of the extremities are considered for payment:
cases of deep vein thrombophlebitis or if symptoms suggest where the possibility of it, such as pain in the limb without explanation or swelling and / or edema.
· patient with symptoms and findings of pulmonary embolism.
· assessment of symptomatic varicose veins such as pain, swelling and leg ulcers, edema that interferes with daily activities that has not responded to conservative therapy after three months of therapy.
· The documentation of venous valvular incompetence prior to a therapeutic intervention.
· The evaluation and selection of a vein to create a fistula or before revascularization.
Given the fact that the symptoms and findings of arterial occlusive disease and venous disease are so divergent that performing arterial and venous studies in the same match is not appropriate for payment.
Extracranial arterial performing studies (CPT 93880 or 93881) and non-invasive evaluation of extremity veins (CPT 93965, 93970 or 93971) during the same encounter is not like widespread protocol therefore do not come for payment.