Duplex scans are a common area of confusion across the country, and 2020 saw the introduction of two new codes for duplex scans, making for a potentially tricky start to the new year. Before we dive in to the new codes, let’s review some general guidelines for noninvasive vascular diagnostic studies.
Noninvasive vascular studies include patient care required to perform the studies. This is the usual pre-procedure work that is bundled into the study performed.
Noninvasive vascular studies include supervision of the study and interpretation of the study result. As with any imaging study, the radiologist must provide an interpretation of the results.
Noninvasive vascular studies require a hard-copy output, with analysis, of all data including bidirectional vascular flow or imaging when provided. The use of a simple hand-held or other Doppler device that does not produce hard copy output, or that produces a record that does not permit analysis of bidirectional vascular flow, is considered to be part of the physical examination of the vascular system and is not separately reported.
Use of color Doppler for anatomic structure identification only, in conjunction with a real-time ultrasound exam, is not reported separately. True vascular analysis must be performed— the use of Doppler simply to determine whether or not a structure is vascular does not constitute true vascular analysis. A full and complete color duplex with waveform analysis must be performed.
A duplex scan characterizes the pattern and direction of blood flow in arteries or veins and produces real-time images integrating B-mode two-dimensional vascular structure, Doppler spectral analysis and color flow Doppler imaging. In the Ultrasound Coding User’s Guide, the ACR specificallystates, “Assessing flow with color, recording a waveform and reporting thefindings in a medically indicated examination are the key elements to lookfor in a report.” In the report you should see documentation of the velocitymeasurements of blood flow, or you might see phrases such as “waveformnormal,” “spectral Doppler showed no flow” or “normal triphasic waveformpatterns using Doppler interrogation” to assign the duplex study codes.
What are the New Codes?
93985 Duplex scan of arterial inflow and venous outflow for preoperative vessel assessment prior to creation of hemodialysis access; complete bilateral study
93986 Duplex scan of arterial inflow and venous outflow for preoperative vessel assessment prior to creation of hemodialysis access; complete unilateral study
These codes describe a unilateral or bilateral scan (of either upper or lower extremity[ies]) performed prior to the construction of a hemodialysis access graft, where the arteries and veins are ultrasonically evaluated to determine the adequacy of the vessels for graft formation.
These complete studies include both arterial inflow and venous outflow evaluation. Other code choices exist for scans evaluating only arterial inflow or only venous outflow as illustrated below:
| Arterial Inflow and Venous Outflow (Prior to Graft Creation) | Arterial Only | Venous Only | |
| Bilateral | 93985 | 93925 (Lower Extremities) 93930 (Upper Extremities) | 93970 |
| Unilateral | 93986 | 93926 (Lower Extremity) 93931 (Upper Extremity) | 93971 |
As you can see, proper application of these new codes (as with all duplex scans) requires a careful examination of the documentation to ensure all required components are in the report. They are very specific in that they are for assessment prior to creation of a dialysis access and must include both arterial inflow and venous outflow. If the report does not meet these criteria, these codes should not be assigned.
As a reminder, both spectral analysis and color flow must be documented to assign any duplex codes, and the report should document the velocity measurements of blood flow. Several terms that indicate spectral analysis are: acceleration rate, monophasic, biphasic or triphasic waveforms, peak systolic velocity, resistive index (RI), velocity, waveform analysis.
Guidance with Noninvasive Vascular Studies, Diagnostic Ultrasound and Other Ultrasound Services
It’s all in the Ultrasound Coder, your one-stop solution. Designed to specifically respond to real-world coding, documentation and billing issues for a full range of ultrasound services with workable solutions, translated into clear-cut instruction, actionable tips and case examples – an invaluable resource for radiology providers.
Let’s dive into a topic that often feels as intricate as the systems it governs—healthcare regulatory compliance. It’s the backbone of a healthcare organization’s commitment
Artificial intelligence (AI) is rapidly becoming a transformative force in various sectors, including healthcare. While much of the focus in healthcare is on clinical applications,
Please log in to your account to comment on this article.
Prepare your organization for the 2025 OPPS updates with expert insights from Tiffani Bouchard, CCS, CRCR, a Revenue Integrity Professional with over 30 years of experience. This webcast will address critical challenges in charge capture and coding, providing clarity on APC policies, C-APC packaging, exclusions, and payer-specific requirements. Attendees will learn actionable strategies to ensure compliance, optimize reimbursement, and mitigate risks of claim denials. Gain the knowledge needed to implement updates effectively, educate your team, and maintain seamless revenue cycle operations in the face of evolving OPPS complexities.
Join Beth Wolf, MD, CPC, CCDS, for an in-depth webcast on the FY2025 spinal fusion MS-DRG updates. Discover key changes in DRG classification, understand impacts on documentation and CMI, and learn strategies to ensure compliance.
Join Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, as she presents effective strategies to strengthen collaboration between CDI, coding, and quality departments in acute care hospitals. Angela will also share guidance on implementing cross-departmental meetings, using shared KPIs, and engaging leadership to foster a culture of collaboration. Attendees will gain actionable tools to optimize documentation accuracy, elevate quality metrics, and drive a unified approach to healthcare goals, ultimately enhancing both patient outcomes and organizational performance.
Optimize your outpatient clinical documentation and gain comprehensive knowledge from foundational practices to advanced technologies, ensuring improved patient care and organizational and financial success. This webcast bundle provides a holistic approach to outpatient CDI, empowering you to implement best practices from the ground up and leverage advanced strategies for superior results. You will gain actionable insights to improve documentation quality, patient care, compliance, and financial outcomes.
The 2025 Medicare Physician Fee Schedule brings significant changes to payment rates, coverage, and coding for physician services, impacting practices nationwide. Join Stanley Nachimson, MS., as he provides a comprehensive guide to understanding these updates, offering actionable insights on new Medicare-covered services, revised coding rules, and payment policies effective January 1. Learn how to adapt your practices to maintain compliance, maximize reimbursement, and plan for revenue in 2025. Whether you’re a physician, coder, or financial staff member, this session equips you with the tools to navigate Medicare’s evolving requirements confidently and efficiently.
Dr. Ronald Hirsch provides critical details on the new Medicare Appeal Process for Status Changes for patients whose status changes during their hospital stay. He also delves into other scenarios of hospital patients receiving custodial care or medically unnecessary services where patient notifications may be needed along with the processes necessary to ensure compliance with state and federal guidance.
Healthcare organizations face complex regulatory requirements under the No Surprises Act and Price Transparency rules. These policies mandate extensive fee disclosures across settings, and confusion is widespread—many hospitals remain unaware they must post every contracted rate. Non-compliance could lead to costly penalties, financial loss, and legal risks. Join David M. Glaser Esq. as he shows you how to navigate these regulations effectively.
Protect your facility from unwanted audits! Join Becky Jacobsen, BSN, RN, MBS, CCS-P, CPC, CPEDC, CBCS, CEMC, and take a deep dive into both the CMS and AMA guidelines for reporting post operative pain blocks. You’ll learn how to determine if the nerve block is separately codable with real life examples for better understanding. Becky will also cover how to evaluate whether documentation supports medical necessity, offer recommendations for stronger documentation practices, and provide guidance on educating providers about documentation requirements. She’ll include a discussion of appropriate modifier and diagnosis coding assignment so that you can be confident that your billing of post operative pain blocks is fully supported and compliant.
Copyright © 2025 ICD10monitor. Powered by MedLearn Media.
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
