El paso integrated physicians group



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EL PASO INTEGRATED PHYSICIANS GROUP

1810 MURCHISON, STE. 300



EL PASO, TX 79902
ULTRASOUND ORDER/BILLING FORM
Provider:______________________________ Date:________________________________
Patient:_______________________________ Ins. #1_______________________________
SS#:__________________________________ Ins. #2_______________________________
DOB:_________________________________ Ref Phys:_____________________________

CIMT & Carotid Doppler

Abdominal Scans

93882

93880

Duplex scan of extracranial arteries: unilateral or limited

Duplex scan of extracranial arteries: bilateral

76705

G0389

Echo Exam of Abdomen, limited

Ultrasound AAA screen *

250.00

Diabetes (Commercial insurance only)*

228.04

Hemangioma of intra-abdominal structures

272.4

Other and unspecified hyperlipidemia (Commercial insurance only)

441.00

Dissection of aortic aneurysm, unspecified site

277.7

Dysmetabolic Syndrome x (Commercial insurance only)

441.01

Dissection of aorta thoracic

346.01

Classical migraine with intractable migraine

441.03

Dissection of aorta thoracoabdominal

346.80

Other Form of Migraine wo mention of intractable migraine wo status migrainosus

441.4

Abdominal Aneurysm

346.90

Migraine unspecified wo mention of intractable migraine wo mention of status migrainosus

785.9

Other symptoms involving cardiovascular system, bruit (arterial)

362.13

Changes in Vascular Appearance of Retina

789.00

Abdominal pain, unspecified site**

368.12

Transient Visual Loss

789.05

Abdominal pain, periumbilic**

368.13

Visual Discomfort

789.06

Abdominal pain, epigastric**

368.14

Visual Distortions of Shape and Size

789.07

Abdominal pain, generalized**

368.2

Vertigo

789.09

Abdominal pain, other unspecified site**

368.40

Visual Field defect, unspecified

789.30

Abdominal or pelvis swelling mass or lump, unspecified site

389.10

Sensorineural Hearing Loss, Unspecified

789.35

Abdominal or pelvis swelling mass or lump, periumbilic

401.9

Hypertension, unspec (Commercial insurance only)

789.36

Abdominal or pelvis swelling mass or lump, epigastric

411.0

Postmyocardial Infarcton Syndrome

789.37

Abdominal or pelvis swelling mass or lump, generalized

412

Old Myocardial Infarction

789.39

Abdominal or pelvis swelling mass or lump, other specified site

413.01

Angina decubitis (chest pain)

789.40

Abdominal rigidity, unspecified site

414.01

Coronary Atherosclerosis of Native Coronary Artery

789.45

Abdominal rigidity, periumbilic

433.10

Occlusion and Stenosis of Carotid Artery w/o Cerebral Infarction

789.46

Abdominal rigidity, epigastric

433.30

Occlusion and Stenosis of multiple and bilateral precerebral arteries w/o cerebral infarction

789.47

Abdominal rigidity, generalized

435.8

Other Specified Transient Cerebral Ischemias

789.49

Other Symptoms involving Cardiovascular system (carotid bruit)

438.0

Cognitive Deficits

789.60

Abdominal tenderness, unspecified site

438.6

Alterations of Sensations

789.65

Abdominal tenderness, periumbilic

438.7

Disturbances of Vision

789.66

Abdominal tenderness, epigastric

438.84

Ataxia (inability to coordinate voluntary muscle movements)

789.67

Abdominal tenderness, generalized

438.85

Late Effect of Cerebrovascular Disease

789.69

Abdominal tenderness, other specified site

780.2

Syncope and Collapse

789.9

Other symptoms involving abdomen and pelvis

781.2

Abnormality of Gait

793.6

Nonspecific (abnormal) findings on radiology and other examination of abdominal area including retroperitoneum

781.3

Lack of Coordination

*Pt must have certain risk factors for Abdominal Aortic – eligible patients must receive a referral for a AAA screening as a result of a PPE
**Abdominal US for abdominal, flank, or back pain, including referred pain, will be closely monitored for aberrant usage

782.0

Disturbance of Skin Sensation

784.2

Swelling, mass or lump in head or neck

784.3

Aphasia, symptoms involving head and neck

785.9

Other Symptoms involving Cardiovascular system (carotid bruit)

787.20

Dysphagia Unspecified (difficulty swallowing)



*Medicare does not allow Diabetes to be coded as a primary condition for any vascular lab
EL PASO INTEGRATED PHYSICIANS GROUP

1810 MURCHISON, STE. 300



EL PASO, TX 79902
ULTRASOUND ORDER/BILLING FORM
Provider:______________________________ Date:________________________________
Patient:_______________________________ Ins. #1_______________________________
SS#:__________________________________ Ins. #2_______________________________
DOB:_________________________________ Ref Phys:_____________________________

Arterial Doppler

Venous Doppler

93925

93926

93930

93931

Arterial Duplex Lower Extremity, bilateral

Arterial Duplex Lower Extremity, unilateral

Arterial Duplex Upper Extremity, bilateral

Arterial Duplex UpperExtremity, unilateral

93970

93971

Venous Duplex, bilateral, includes compression

Venous Duplex, unilateral or limited, includes compression

250.70

Diabetes II w/peripherial circulatory disorder, not stated as uncontrolled

411.89

Other acute and subacute forms of ischemic heart disease, other

250.71

Diabetes I w/peripherial circulatory disorder, not stated as uncontrolled

412

Old Mycardial Infarction

250.72

Diabetes II w/peripherial circulatory disorder, uncontrolled

413.0

Angina Decubitus

250.73

Diabetes I w/peripherial circulatory disorder, uncontrolled

413.1

Prinzmetal Angina

411.0

Postmycardial Infarction Syndrome

414.0

Coronary Atherosclerosis of native coronary artery

411.1

Immediate Coronary Syndrome

414.8

Other specified forms of chronic ischemic heart disease

411.89

Other acute/subacute ischemic heart disease, other

440.0

Atherosclerosis of aorta

412

Old Myocardial Infarction

440.1

Atherosclerosis of renal artery

413.0

Angina Decubitus

440.20

Atherosclerosis of native arteries of the extremities, unspecified

413.1

Prinzmetal Angina

440.21

Atherosclerosis of native arteries of the extremities, w/intermit claudication

413.9

Other and unspecified Angina Pectoris

440.22

Atherosclerosis of native arteries of the extremities, w/rest pain

414.8

Other specified forms of chronic ischemic heart disease

444.22

Arterial embolism and thrombosis of lower extremity

440.0

Atherosclerosis of aorta

451.2

Phlebitis and thrombophlebitis of lower extremities, unspecified

440.20

Atherosclerosis of native arteries of the extremities, unspecified

453.79

Chronic venous embolism and thrombosis of specified veins

440.21

Atherosclerosis of native arteries of the extremities, w/intermit claudication

453.89

Acute venous embolism and thrombosis of other specified veins

440.22

Atherosclerosis of native arteries, extremities, w/rest pain

454.0

Varicose vein of lower extremity with ulcer

443.0

Raynaud’s syndrome

454.1

Varicose vein of lower extremity with inflammation

443.1

Thromboangitis Obliterans

454.2

Varicose vein of lower extremity with ulcer and inflammation

443.9

Peripheral Vascular Disease, unspecified

454.8

Varicose vein of lower extremity with other complications

444.89

Embolism and Thrombosis of other artery

459.2

Compression of vein

445.01

Atherembolism of upper extremities

459.30

Chronic venous hypertension without complications

455.02

Atherembolism of lower extremities

459.39

Chronic venous hypertension with other complication

447.0

Arteriovenous Fistula acquired

518.81

Acute Respiratory Failure

447.1

Stricture of Artery

682.6 682.7

Cellulitis and abscess leg except foot; foot except toes

447.6

Arteritis unspecified

682.2 682.3 682.4

Cellulitis and abscess trunk; upperarm and forearm; hand except fingers

585.3 585.4 585.5 585.6

Chronic Kidney Disease stage III; stage IV; stage V; end stage renal disease

585.3

585.4

585.5

585.6

Chronic Kidney Disease stage III; stage IV; stage V; end stage renal disease

719.45

Pain in joint involving pelvic region and thigh

729.5

Pain in limb

747.60

Anomaly of peripheral vascular system, unspecified site

729.81

Swelling of limb

789.30

Abdominal or pelvic swelling mass or lump, unspec. site

747.69

Anomalies of other specified sites of peripheral vascular system

789.37

Abdominal or pelvic swelling mass or lump, generalized

782.2

Localized superficial swelling mass or lump

903.8

Injury to other specified blood vessels of upper extremity

782.3

Edema

904.7

Injury to other specified blood vessels of lower extremity

782.9

Other symptoms involving skin and other integumentary tissue (change in skin texture)







789.37

Abdominal or pelvic swelling mass or lump, generalized







997.2

Peripheral vascular complications, not elsewhere classified



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