LCD Reference Article Response To Comments Article

Response to Comments: Peripheral Venous Ultrasound

A59602

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Article ID
A59602
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Article Title
Response to Comments: Peripheral Venous Ultrasound
Article Type
Response to Comments
Original Effective Date
12/14/2023
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The following are the comment summaries and contractor responses for First Coast Service Options Proposed Local Coverage Determination (LCD) DL33693 Peripheral Venous Ultrasound which was posted for comment on August 3, 2023 and presented at the August 17, 2023 Open Meeting. All comments were reviewed and incorporated into the final LCD where applicable.

Response To Comments

Number Comment Response
1

A comment was received regarding several diagnosis codes that are missing from DA52993. Commenter noted that R60.9, R06.02, J96.01, R07.9, R60.9, L97.111-L97.829 are missing from the draft article. Commenter noted that these diagnosis codes are in the current Article A52993. Commenter inquired if these diagnosis codes were omitted in error. No references were cited or included with this comment.

Thank you for your comment. We will address as follows: 1/ Multiple pulmonary embolism diagnoses codes are covered in the current article A52993. The initial workup of pulmonary embolism should not include an extremity ultrasound. Therefore, acute respiratory failure with hypoxia, shortness of breath and chest pain (unspecified) will not be added. 2/ In the investigation of an ulcer there may not be an established diagnosis of varicose veins or post-phlebitic syndrome. After review, we agree to add the requested ICD-10-CM code R60.9 "Edema, unspecified" as another option for edema and also agrees to add coverage for the following non-pressure chronic ulcer codes: L97.111-L97.119, L97.121-L97.129, L97.211-L97.219, L97.221-L97.229, L97.311-L97.319, L97.321-L97.329, L97.411-L97.419, L97.421-L97.429, L97.511-L97.519, L97.521-L97.529, L97.811-L97.819, and L97.821-L97.829. In the LCD, in the "Covered Indications" section Indication #1, 'Investigation for DVT as the source of a suspected or confirmed PE' has been revised to 'Investigation for DVT as the source of a confirmed PE'.

2

A comment was received from Texas Health Resources requesting that ICD-10-CM code M79.89 Other specified soft tissue disorders be added to the ICD-10-CM Codes that Support Medical Necessity for CPT codes 93970 and 93971. The commenter noted that extremity swelling is a covered indication for this test to rule out DVT. The commenter stated that ICD-10-CM manual indicates "Swelling"→"arm" and "Swelling" →"leg" are both coded to M79.89. No references were cited or included with this comment.

Thank you for your comment. The ICD-10-CM code M79.89 "other specified soft tissue disorder" is not specific to edema and will not be added. After review, we agree to add ICD-10-CM code R60.9 "Edema, unspecified" as another option for edema.

3

A comment was received from the Dialysis Vascular Access Coalition requesting that dialysis access related venous ultrasound/duplex services be added to the LCD to avoid issues when the 93970 code may be used for a dysfunctional AV access. The commenter also requested that the following additional CPT codes be included for the ESRD population whose access has a medical indication for ultrasound study: 93985 93986, and 93990. Commenter stated that Medicare considers a Doppler flow study medically necessary when the patient's dialysis access site manifests signs or symptoms associate with vascular compromise and when the results of this test are necessary to determine the clinical course of treatment. The commenter cited Doppler flow study information from CMS Pub 100-02 Medical Benefit Policy Manual, Chapter 11 End Stage Renal Disease (ESRD), Section 40, H. The commenter cited the ACR-AIUM-SRU Practice Parameter for the Performance of Vascular Ultrasound for Postoperative Assessment of Hemodialysis Access (2019) indications for hemodialysis ultrasound. The commenter requested the addition of the following ICD-10-CM codes: I77.0, N18.4, N18.5, N18.6, T82.510A, T82.520A, T82.530A, T82.590A, T82.818A, T82.828A, T82.838A, T82.848A, T82.858A, T82.868A, T82.898A, and Z01.818. The commenter cited CMS Pub 100-02 Medicare Benefit Policy Manual, Chapter 11-End Stage Renal Disease (ESRD), Section 40, H.

Thank you for your comment. The Internet Only Manual (IOM) includes coverage information for hemodialysis services. The IOM Publication 100-04 Medicare Claims Processing Manual Chapter 8, Section 180 Noninvasive Studies for ESRD Patients - Facility and Physician Services states "Where there are signs and symptoms of vascular access problems, Doppler flow studies may be used as a means to obtain diagnostic information to permit medical intervention to address the problem. Doppler flow studies may be considered medically necessary in the presence of signs or symptoms of possible failure of the ESRD patient's vascular access site, and when the results are used in determining the clinical course of the treatment for the patient". The current policy does not apply to hemodialysis venous services. Thus, the suggested CPT and ICD-10-CM codes will not be added to the Article.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L33693 - Peripheral Venous Ultrasound
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Updated On Effective Dates Status
12/08/2023 12/14/2023 - N/A Currently in Effect You are here

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