Name That Guideline
This GL may be used for surveillance to follow up on a member with an Abdominal Aortic Aneurysm
PVD 6.3
CPT codes 93880 or 93882 would be initial evaluation for possible carotid artery disease for a member with a carotid bruit
Duplex Ultrasound of extracranial arteries bilateral or Unilateral PVD 3.1
This study should be performed prior to a MRV or CTV for a member with symptoms of venous insufficiency including but not limited to unilateral pain and swelling of the upper extremity
93971 and 93970 venous duplex of upper extremities should be performed first PVD 4.1
This study may be indicated following a duplex to confirm degree of stenosis in members with between 50% and 70% carotid stenosis seen on a on duplex US
A one time CTA Neck (CPT® 70498) can be approved to confirm degree of stenosis in patients with ulcerated plaque or heavy calcification on a duplex
PVD 3.2
PVD-3.1
CPT codes 93970 or 93971 is the initial study for any suspected DVT in a member with symptoms such as swelling, pain, or warmth.
Duplex Ultrasound of extremity veins bilateral or unilateral PVD 12.2
This should be performed first before a duplex ultrasound for a member with suspected superficial venous thrombosis.
The diagnosis of superficial venous thrombosis is generally made on the basis of physical examination first
PVD 12.1
These studies may be indicated following an open descending thoracic aortic aneurysm repair
One of the following, CT chest w contrast (CPT® 71260), CT chest without contrast (CPT® 71250) or CTA chest (CPT® 71275), can be obtained
3-6 months postoperatively
12 months postoperatively
And then every two years thereafter
PVD 6.8
This GL may be used for a member for surveillance of an iliac stent
PVD 17.1 Post Iliac vein stenting/angioplasty
CPT code 73225 is one of the appropriate studies for suspected Fibromuscular Dysplasia
MRA of Upper extremity PVD 4.1
This is ONE of the reasons we would need first before advanced imaging on a member with an IVC filter
New bilateral lower extremity swelling (venous duplex should be performed first)
PVD 16.2
This study may be indicated following an upper extremity arterial revascularization
Arterial Duplex (CPT® 93931) can be obtained following upper extremity arterial revascularization at: Baseline (within one month) 6 months Then annually if stable Anytime for new or worsening symptoms
PVD 4.1
This GL may be used for a member who is having calf or thigh cramping with exertion that is relieved completely with rest.
PVD 7.1 Claudication
CPT code 93975 is one of the codes that may be indicated for surveillance of iliac venous stents
Arterial Duplex arterial inflow and venous outflow of abdomen, retroperitoneum, scrotal contents and/or pelvic organs. PVD 17.1
This needs to be suspected first before ordering a CTA or MRA of the entire aorta
Acute dissection of the aorta must be suspected
PVD 6.7
This study will follow an infrainguinal Endovascular Revascularization Femoropopliteal angioplasty/stent
Clinical exam and ABI with arterial duplex
1 month
3 month
Every 6 months for two years
Then annually PVD 7.3
This GL may be used for a member with a celiac artery aneurysm
PVD 6.5 Visceral Artery Aneurysm
CPT codes 71260 71250 71275 71555 are imaging studies that may be indicated for a follow up of descending aortic aneurysms which are medically treated
CT Chest with contrast 71260
CT Chest without contrast 71250
CTA Chest 71275
MRA Chest 71555
PVD 6.2
This study must be performed first before an MRA upper Extremity may be indicated for a member prior to AV Fistula creation.
CPT® 93985 or 93986
for vessel mapping must be performed first and if equivocal then the MRA may be ordered
PVD 8.1
This study may be indicated after diagnosis of AVM for surveillance purposes
MRA (contrast as requested) of the affected body part can be approved for evaluation and surveillance of known AVMs.
PVD 9.1