CPT® Code 93965

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1. Indications

The noninvasive physiologic studies of extremity veins, as described by CPT® Code 93965, are indicated for various clinical scenarios where assessment of venous function is necessary. These indications may include:

• Suspected Venous Insufficiency - Patients presenting with symptoms such as leg swelling, pain, or heaviness may require these studies to evaluate venous function.
• Diagnosis of Deep Vein Thrombosis (DVT) - The procedure is often utilized to help confirm or rule out the presence of blood clots in the deep veins of the extremities.
• Assessment of Varicose Veins - Individuals with varicose veins may undergo these studies to understand the underlying venous pathology.
• Preoperative Evaluation - Prior to surgical interventions, these studies can provide essential information regarding venous health and function.
• Monitoring of Venous Disease Progression - Patients with known venous disorders may require periodic assessments to monitor changes in their condition.

2. Procedure

The procedure for CPT® Code 93965 involves several key steps to ensure comprehensive evaluation of the extremity veins. The following procedural steps are typically performed:

• Step 1: Patient Preparation - The patient is positioned comfortably, and the extremities to be studied are exposed. A thorough history and physical examination are conducted to identify any specific areas of concern.
• Step 2: Doppler Waveform Analysis - A Doppler ultrasound device is used to assess blood flow in the veins. The physician applies a transducer to the skin over the veins, measuring the velocity of blood flow. This may include baseline measurements as well as assessments during compression maneuvers to observe changes in blood flow dynamics.
• Step 3: Phleborheography - This technique involves placing sensors on the skin to measure changes in venous volume in response to respiratory movements or external compression. The data collected helps in understanding the venous return and any abnormalities present.
• Step 4: Impedance Plethysmography - Similar to phleborheography, this method measures changes in electrical impedance in the veins as they fill and empty with blood. The physician inflates and deflates a blood pressure cuff to create controlled changes in venous pressure, allowing for detailed analysis of venous function.
• Step 5: Ankle/Brachial Index Measurement - In some cases, the ankle/brachial index may be measured using a Doppler stethoscope to assess blood flow at the ankle and compare it to the flow at the arm, providing additional information about vascular health.
• Step 6: Documentation and Interpretation - After completing the measurements, the physician documents the findings and provides a written interpretation, summarizing the results and any clinical implications for further management.

3. Post-Procedure

Post-procedure care for patients undergoing CPT® Code 93965 is generally minimal due to the noninvasive nature of the studies. Patients may resume normal activities immediately following the procedure. However, they should be advised to monitor for any unusual symptoms, such as increased pain, swelling, or changes in skin color in the extremities. The physician will typically schedule a follow-up appointment to discuss the results of the study and any necessary further evaluations or treatments based on the findings. It is essential for the physician to communicate the results clearly to the patient and outline any subsequent steps in their care plan.