CPT Code 93971

(2022) CPT Code 93971 Description, Guidelines, Reimbursement, Modifiers & Examples

CPT code 93970 refers to a “complete bilateral study.” Following CPT code 93971, “unilateral or limited study” means only that. Both 93970 and 93971 can be used for bilateral research; 93970 for complete research and 93971 for limited. 

CPT Code 93971 Description

Duplex scanning arteries to measure blood flow is a noninvasive vascular diagnostic method. Peripheral vascular flow patterns can be studied using real-time ultrasound imaging and pulsed Doppler.

As a result of this treatment, it is possible to determine whether or not there are any obstructed or stenotic veins in the arteries.

Suppose an upper and lower extremity complete or partial bilateral study is performed. The appropriate code can be reported once (i.e., once for the upper and lower extremities). 

93971 cpt code

The modifier used for CPT code 93971 by a different provider should be applied to the second code to show that two different studies were completed in CTP codes 93970 and CPT code 93971.

A written report or interpretation should be generated for each study carried out. The CPT/HCPCS code 93965 was eliminated in the annual CPT/HCPCS code changes.

As of this writing, CPT code 93965 has no successor code. Therefore, a “not otherwise classified” (NOC) designation is inappropriate for this service.

 CPT code 93971 should be used to document either a partial or full unilateral stud. Only one service has to be reported. It is not permissible to use the -50 modifier with CPT code 93971 for a limited bilateral trial.

 Codes 93970 and 93971 are distinct in more ways than one. When reporting on 93970, it must meet the definition of a comprehensive bilateral investigation. 93971 is a unilateral or limited study for a limited bilateral or unilateral service.

93971 cpt code description

 Codes 93970 and 93971 are distinct in more ways than one. A study under the heading “93970” must meet all of the criteria listed in this definition. In addition, 93971 is a study that can be used for both a limited bilateral and a limited unilateral service since it is unilateral or limited in scope.

It is necessary to know how many vessels were photographed, whether the service is bilateral, and whether the deep and superficial systems were examined for reporting purposes.

To paraphrase the saying, “The golden rule is to perform only what is necessary and report only what you have done.”

Two-dimensional structure and motion, time and Doppler ultrasonic signal recording, spectral analysis, and color flow velocity mapping or imaging are some functions that a duplex scan can perform.

An independent piece of equipment is used for noninvasive physiologic examinations rather than the duplex scanners. Besides pressure measurements, a full extremities physiologic assessment may also include Doppler ultrasound or plethysmography.

 It is more than simply one or the other for the CPT codes 93970 and 93971 for duplex scans. When reporting on 93970, it must meet the strict definition of comprehensive bilateral research.

CPT code 93971 is a study that can be used for both a limited bilateral and a limited unilateral service since it is unilateral or limited in scope.

All deep veins in the leg, including the gastrocnemius and anterior and posterior tibia veins, and the common and deep femoral veins are examined for a complete evaluation. Afterward, the superficial veins, including the sacroiliac, perforating, and tributary veins, are evaluated.

93971 cpt code reimbursement
CPT code 93965 – Deleted 01 Jan 2017

 A full-duplex scanning test for CVD should include visibility, deformability, and vascular flow, assessing the duration of regurgitation, enhancement, physicality, and vein size. 

A cutoff value of 500 milliseconds is set for the saphenous, tibial, deep, and perforating veins, whereas the femoral and popliteal veins have a cutoff of one second.”The study must be documented with 93971 if even one item is absent or not addressed in the interpretation, leading to medical need

CPT code 93971 should be used for either a restricted bilateral or complete unilateral study (only one service should be reported). Using a -50 modifier with CPT 93971 for a limited bilateral study.

It is not just unilateral vs. bilateral that separates codes 93970 and 93971. When reporting on 93970, it must meet the strict definition of comprehensive bilateral research. It is possible to use research code 93971 for both a limited bilateral and a unilateral application.

CPT Code 93971 Billing Guidelines

CPT 93970 An extensive bilateral examination involving duplex imaging of the extremity veins and the reaction to compression and other motions. It is possible to study the jugular veins in duplex mode.

All subsequent claims will also be denied if a claim is denied due to 93925 and 93880. An appeal for a medical evaluation within the LCD established ICD limitations for medical necessity must be made on all denied claims.

Noninvasive vascular exams for hemodialysis access monitoring using CPT codes different from 93990 are considered to misrepresent the service provided. 

Data from noninvasive diagnostic examinations of limbs will be examined ongoing. As part of their regular program protection procedures, contractors should handle any abnormal findings.

Extremity veins can be examined for signs of vascular incompetence or DVT using CPT codes 93970 (duplicate scan), complete bilateral inspection, or CPT code 93971 (complete bilateral investigation) (unilateral or limited study).

G0365 is the Medicaid identifier for vascular tracing and the creation of an autogenous hemodialysis fistula. 

The code requires an assessment of the suitable arteries and veins. This code is used for all following vein mapping procedures (CPT code 93971).

Check to see whether your insurance covers this procedure. Those without a history of severe varicose veins or DVT may not be eligible for benefits.

Accordingly, CPT codes 36475, +36476, 36478, and +36479 describe electromagnetic and laser saphenous vein ablation procedures. Ultrasonography guidance for these procedures is no longer individually reportable because the new codes include all imaging information.

 The preoperative extremities duplex to detect and define venous insufficiency can sometimes still be reported independently, even though carrier recommendations differ in this area.

Both 93970 and CPT code 93971, a duplex scan of the extremities veins, can be used for a complete or partial assessment.

To bill for the EVAT’s accompanying extremity venous duplex imaging (93970–93971), a modifier must be applied to the EVAT’s accompanying diagnostic extremity Doppler ultrasound (93970–93971)

It is necessary to bill 93970 and CPT code 93971 twice, depending on whether the upper or lower extremities have venous duplex scans.

For example, it would be incorrect to report 93970 for the left arm and right leg images. Please report CPT code 93971 twice in this case. The modifier -59 (distinct procedural service) is necessary to specify that the second code is for a different body location.

CPT Code 93971 Modifiers

The 59 modifiers distinguish between the RVU CPT code 93971 and the procedure code 93970. If the exam was prepared at a different level and is not covered by bilateral exam number 93970, the modifier will help determine if the exam is eligible for reimbursement.

When describing a “complete bilateral study,” CPT code 93970 is commonly used. According to CPT code 93971, a “single or limited” study. When conducting a bilateral study, you can use 93970 and 93971; 93970 for comprehensive research and 93971 for more limited research. 

Suppose both the upper and lower extremities are subjected to a complete or partial bilateral investigation. Then, the appropriate code should only be entered once (i.e., once for the upper extremities and once for the lower extremities). 

A different provider’s medical examination repeat service should be attached to the second code to show two separate, unique studies were completed. In addition, a written report or interpretation should be generated for each study carried out.

Reimbursement

Medicare may cover ultrasound services if they are medically necessary and within the scope of the provider’s license. Under Medicare standards, all image-guided procedures are covered by the reimbursement for the underlying procedure.

 Ultrasound guidance is included in the underlying procedure’s cost. As a result, no one can know exactly what this data means. The Medicare MS-DRG payment system would include expenditures for ultrasound services in a hospital inpatient setting, and payment would be handled. 

In any event, the doctor is free to fee for his or her services. Medicare may fund ultrasound services if they are medically necessary and within the extent of the provider’s licensure. Vein duplex scan, including responses to compression and other operations; unilateral or limited research.

CPT Code 93971 Examples 

The following examples are when CPT code 93971 may be used.

Example 1

Suppose the doctor will do a Duplex scan on the extremities of the right leg to identify the source of the discomfort. After doing the test, the doctor concludes that there are no anomalies in the veins.

We will code the signs and symptoms as the primary diagnosis in compliance with outpatient coding regulations because no clear diagnosis has been made.

Because of this, the scenario will record right leg edema as the primary diagnosis, with operation CPT code 93971 – RT.

Example 2

\Moreover, this is a one-of-a-kind situation. There may be an order for a duplex scan if a patient complains of pain in the right upper arm and extremities.

After the test, the doctor finds no anomalies in the patient’s upper extremities and vein thrombosis in the femoral right and left veins.

The following CPT codes must be used to code the diagnosis associated with the scenario mentioned above before being reported.

The modifier is -59 or X 

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