Vascular Ultrasound

DuplexAnd Doppler Studies

Int roduct ion

Many facilities bill diagnostic vascular ultrasound services from the referring physician?s order as an automated process, without any review by a coding professional This practice can result in an inaccurate code if the interpreting professional fails to meet the specific documentation requirements for vascular ultrasound examinations.

The radiology report serves as the documentation for both the professional and technical portions of the examination The documentation within the medical record must support the exam that was performed--both for the professional fee (the radiologist?s interpretation) and the technical fee (the technologist?s work of performing the exam). It is the reading radiologist?s responsibility to ensure the components of each diagnostic ultrasound exam performed are documented appropriately in the radiology report

The CPT® guidelines state that all diagnostic ultrasound studies require the following:

- Permanently recorded images with measurements (when such measurements are clinically indicated)

- A final, written report to be issued for inclusion in the patient?s medical record

Per CPT® , ?Use of ult rasound, w it hout t horough evaluat ion of organ(s) or anat om ic region, im age docum ent at ion, and final, w rit t en report , is not separat ely report able.?

Duplex vs Doppler

Duplex and Doppler scans can be perplexing due to redundant terminology and lack of necessary documentation.

Both non-invasive vascular studies and duplex scans use Doppler ultrasound to evaluate blood flow in the vessels.

Vascularultrasound

The CPT® manual specifies two required capabilities for Doppler units:

- Producing hard copy output (printable waveforms)

- Allowing bidirectional flow analysis (some handheld Doppler units are able to identify a blood vessel by verifying the presence of flow, but cannot assess the direction)

Doppler exams performed without these characteristics are considered part of the patient's physical exam and should not be reported separately.

A duplex scan is a vascular ultrasound that examines the characteristics (such as speed and direction) of blood flow in a vein and/or artery. It merges real-time imaging (2D B-mode ultrasound) with two modes of Doppler ultrasound: spectral Doppler and color Doppler. Color Doppler produces a color image of the vessel overlaid on a B-mode ultrasound image, showing both structure and blood flow velocity and direction

Spectral Doppler presents a graphic display of Doppler data, with jagged vertical lines called waveforms representing flow velocity The vertical axis shows flow velocity in centimeters per second. Higher spikes represent more rapid within blood flow in the vessel. Spectral and color Doppler must both be performed and documented to substantiate a duplex code.

Per the CPT® manual, a duplex scan requires ?real-time images integrating B-mode two dimensional vascular structure, Doppler spectral analysis, and color flow Doppler imaging.? Per Clinical Examplesin Radiology(Winter 2015), when color Doppler is performed alone (without spectral Doppler) to visualize anatomic structures with concurrent real-time ultrasound, it is included in the non-vascular ultrasound code