How To Use CPT Code 93990

CPT 93990 describes the non-invasive duplex scan of hemodialysis access, which includes evaluating the arterial inflow, body of the access, and venous outflow. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 93990?

CPT 93990 is used to describe a non-invasive duplex scan of hemodialysis access. This procedure involves evaluating the arterial inflow, body of the access, and venous outflow of a hemodialysis graft using duplex ultrasound scanning. The purpose of this scan is to assess the condition of the graft and ensure proper blood flow.

2. Official Description

The official description of CPT code 93990 is: ‘Duplex scan of hemodialysis access (including arterial inflow, body of access, and venous outflow).’ This code specifically refers to the non-invasive evaluation of the hemodialysis access using duplex ultrasound scanning.

3. Procedure

1. The healthcare provider performs a non-invasive duplex scan of the hemodialysis access using ultrasound equipment capable of duplex Doppler and color flow mapping.
2. The provider evaluates the arterial inflow, assessing the size, wall structure, Doppler flow characteristics, velocity, and any evidence of stenosis.
3. The connection between the artery and vein is examined for any abnormalities, such as intimal overgrowth, thrombosis, aneurysm, pseudoaneurysm, hematoma, or seroma.
4. The venous outflow of the graft is evaluated, looking for increased velocity, diminished pulsatility, compressibility, and any evidence of thrombus within the vessel.
5. If necessary, the provider may also examine the arterial runoff vessel in the hand.

4. Qualifying circumstances

CPT 93990 is typically performed on patients with hemodialysis grafts to assess the condition of the access. It is used to evaluate the arterial inflow, body of the access, and venous outflow. The procedure is non-invasive and involves the use of duplex ultrasound scanning to obtain detailed images and measurements of the graft. This code should only be used when there is a medical indication for a duplex flow study, as determined by local coverage decisions or LCDs.

5. When to use CPT code 93990

CPT code 93990 should be used when a non-invasive duplex scan of hemodialysis access is performed to evaluate the arterial inflow, body of the access, and venous outflow. This code is appropriate when there is a medical indication for the procedure, such as suspected stenosis or other abnormalities in the graft. It is important to ensure that the documentation supports the medical necessity of the scan.

6. Documentation requirements

To support a claim for CPT 93990, the healthcare provider must document the following information:

• Medical indication for the duplex scan
• Detailed findings of the arterial inflow, body of the access, and venous outflow
• Measurements and assessments of the graft, including size, wall structure, flow characteristics, velocity, and any abnormalities
• Documentation of any abnormalities or concerns identified during the scan
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 93990, ensure that the procedure meets the criteria for a non-invasive duplex scan of hemodialysis access. The documentation should support the medical necessity of the scan and include detailed findings. It is important to follow any local coverage decisions or LCDs regarding the use of this code. Additionally, be aware that Medicare may deny separate billing of the technical component of this code for end-stage renal disease patients covered under monthly capitation payment.

8. Historical information

CPT 93990 was added to the Current Procedural Terminology system on January 1, 1995. There have been no updates or changes to the code since its addition.

9. Examples

1. A healthcare provider performs a non-invasive duplex scan of a hemodialysis access graft to evaluate the arterial inflow, body of the access, and venous outflow. The scan reveals evidence of stenosis in the arterial inflow, prompting further intervention.
2. During a routine follow-up appointment, a patient with a hemodialysis graft undergoes a non-invasive duplex scan to assess the condition of the access. The scan shows normal flow and no abnormalities in the arterial inflow, body of the access, or venous outflow.
3. A healthcare provider performs a non-invasive duplex scan of a hemodialysis access graft on a patient experiencing decreased blood flow during dialysis. The scan reveals a thrombus in the venous outflow, requiring immediate intervention.
4. As part of a preoperative evaluation, a patient with a hemodialysis graft undergoes a non-invasive duplex scan to assess the condition of the access. The scan shows normal flow and no abnormalities in the arterial inflow, body of the access, or venous outflow.
5. A healthcare provider performs a non-invasive duplex scan of a hemodialysis access graft on a patient with suspected stenosis. The scan confirms the presence of stenosis in the arterial inflow, leading to a referral for further intervention.
6. During a routine check-up, a patient with a hemodialysis graft undergoes a non-invasive duplex scan to monitor the condition of the access. The scan shows normal flow and no abnormalities in the arterial inflow, body of the access, or venous outflow.
7. A healthcare provider performs a non-invasive duplex scan of a hemodialysis access graft on a patient experiencing pain and swelling in the access site. The scan reveals an aneurysm in the body of the access, requiring immediate intervention.