Project Overview
The major vessels that extend from the aorta up through the neck on either side.
What is the carotid arteries?
The duplex scan of extracranial arteries; complete bilateral study.
What is CPT 93880?
The documentation elements assessed during the medical review process.
What is Order/Intent to order, Diagnostic results, Signature requirements and Medical Necessity?
Minimum documentation requirements of diagnostic testing are found in the applicable________?
What is LCD/LCA?
A small handheld probe (or trnasducer) pressed upon the skin, sends high pitched sound waves that penetrate tissue and bounce off the blood vessels.
What is Ultrasound technology?
The physician or other qualified health care professional component is reported separately.
What is Modifier 26?
Must be signed by the treating physician/NPP.
What is the Physician order?
The documentation supports the services as reasonable and Necessary.
What is Medical Necessity?
Laboratory testing of blood, body fluids and genetic markers.
What is diagnostic testing to determine the presence of arterial disease without the onset of any symptoms?
Under certain circumstances, a charge may be made for the technical component alone.
What is modifier TC?
Documentation used to support intent must have valid physician/NPP signature.
What is intent to order?
Non-invasive vascular studies done for screening purposes (i.e., without signs or symptoms of disease are not covered by Medicare.
What is not reasonable and necessary?
Most individuals are unaware of issues involving the carotid arteries as symptoms often lack severity or are absent entirely. Instead, the first sign of disease for most is________________.
What is a transient ischemic attack (TIA) or stroke?
Contractual Obligation (provider is financially liable)
What is code CO?
The SMRC will make a phone call to the referring/ordering provider for additional documentation requests in accordance with applicable authorities as needed.
What is Third Pary ADRs?
Information used to support the service as reasonable and necessary may be found in a format that includes ______, _______, ________, _______, ________. The reviewer must assess the medical record holistically to determine whether the supporting elements are met.
What is encounter visits, H&P, Cardiac Risk Factors Assessment, order, and/or results findings?
Conditions can be identified by a healthcare provider through neck examinations using a stethoscope to assess for sounds of blood flow disturbance.
What is a bruit?
Patient Responsibility (Beneficiary is financially liable)
What is code PR?
According to each LCD there is criteria that includes should and shall language. A should is a recommendation and a MUST is a requirement. If/where this appears as “SHOULD” language is used in the LCD’s, reviewers will not issue denials based on “should” language/requirements. The reviewer will submit a ____ if there is a question regarding a should statement in the LCD/LCA.
What is consult?
For LCD L35753 Tests may not be considered medically necessary if performed for the following signs and symptoms.
what is