DUPLEX SCAN OF EXTRACRANIAL ARTERIES - Oxford Health Plans

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T82.320AT82.321AT82.322AT82.328AT82.329AT82.330AT82.331AT82.332AT82.338AT82.339AT82.390AT82.391AT82.392AT82.398AT82.399AT82.41XAT82.42XAT82.43XAT82.49XAT82.510AT82.511AT82.513AT82.514AT82.515AT82.518AT82.520AT82.521AT82.523AT82.524AT82.525AT82.528AT82.529AT82.530AT82.531AT82.533AT82.534AT82.535AT82.538AT82.590AT82.591AencounterDisplacement of aortic (bifurcation) graft (replacement), initialencounterDisplacement of carotid arterial graft (bypass), initial encounterDisplacement of femoral arterial graft (bypass), initial encounterDisplacement of other vascular grafts, initial encounterDisplacement of unspecified vascular grafts, initial encounterLeakage of aortic (bifurcation) graft (replacement), initial encounterLeakage of carotid arterial graft (bypass), initial encounterLeakage of femoral arterial graft (bypass), initial encounterLeakage of other vascular grafts, initial encounterLeakage of unspecified vascular graft, initial encounterOther mechanical complication of aortic (bifurcation) graft(replacement), initial encounterOther mechanical complication of carotid arterial graft (bypass), initialencounterOther mechanical complication of femoral arterial graft (bypass), initialencounterOther mechanical complication of other vascular grafts, initialencounterOther mechanical complication of unspecified vascular grafts, initialencounterBreakdown (mechanical) of vascular dialysis catheter, initial encounterDisplacement of vascular dialysis catheter, initial encounterLeakage of vascular dialysis catheter, initial encounterOther complication of vascular dialysis catheter, initial encounterBreakdown (mechanical) of surgically created arteriovenous fistula,initial encounterBreakdown (mechanical) of surgically created arteriovenous shunt,initial encounterBreakdown (mechanical) of balloon (counterpulsation) device, initialencounterBreakdown (mechanical) of infusion catheter, initial encounterBreakdown (mechanical) of umbrella device, initial encounterBreakdown (mechanical) of other cardiac and vascular devices andimplants, initial encounterDisplacement of surgically created arteriovenous fistula, initialencounterDisplacement of surgically created arteriovenous shunt, initialencounterDisplacement of balloon (counterpulsation) device, initial encounterDisplacement of infusion catheter, initial encounterDisplacement of umbrella device, initial encounterDisplacement of other cardiac and vascular devices and implants,initial encounterDisplacement of unspecified cardiac and vascular devices andimplants, initial encounterLeakage of surgically created arteriovenous fistula, initial encounterLeakage of surgically created arteriovenous shunt, initial encounterLeakage of balloon (counterpulsation) device, initial encounterLeakage of infusion catheter, initial encounterLeakage of umbrella device, initial encounterLeakage of other cardiac and vascular devices and implants, initialencounterOther mechanical complication of surgically created arteriovenousfistula, initial encounterOther mechanical complication of surgically created arteriovenous12Duplex Scan of Extracranial Arteries: Clinical Policy (Effective 11/01/2012)©1996-2012, Oxford Health Plans, LLC
T82.593AT82.594AT82.595AT82.598AT82.817AT82.818AT82.827AT82.828AT82.837AT82.838AT82.847AT82.848AT82.857AT82.858AT82.867AT82.868AT82.897AT82.898AT82.9XXAT83.81XAT83.82XAT83.83XAT83.84XAT83.85XAT83.86XAT83.89XAT83.9XXAT84.81XAT84.82XAshunt, initial encounterOther mechanical complication of balloon (counterpulsation) device,initial encounterOther mechanical complication of infusion catheter, initial encounterOther mechanical complication of umbrella device, initial encounterOther mechanical complication of other cardiac and vascular devicesand implants, initial encounterEmbolism of cardiac prosthetic devices, implants and grafts, initialencounterEmbolism of vascular prosthetic devices, implants and grafts, initialencounterFibrosis of cardiac prosthetic devices, implants and grafts, initialencounterFibrosis of vascular prosthetic devices, implants and grafts, initialencounterHemorrhage of cardiac prosthetic devices, implants and grafts, initialencounterHemorrhage of vascular prosthetic devices, implants and grafts, initialencounterPain from cardiac prosthetic devices, implants and grafts, initialencounterPain from vascular prosthetic devices, implants and grafts, initialencounterStenosis of cardiac prosthetic devices, implants and grafts, initialencounterStenosis of vascular prosthetic devices, implants and grafts, initialencounterThrombosis of cardiac prosthetic devices, implants and grafts, initialencounterThrombosis of vascular prosthetic devices, implants and grafts, initialencounterOther specified complication of cardiac prosthetic devices, implantsand grafts, initial encounterOther specified complication of vascular prosthetic devices, implantsand grafts, initial encounterUnspecified complication of cardiac and vascular prosthetic device,implant and graft, initial encounterEmbolism of genitourinary prosthetic devices, implants and grafts,initial encounterFibrosis of genitourinary prosthetic devices, implants and grafts, initialencounterHemorrhage of genitourinary prosthetic devices, implants and grafts,initial encounterPain from genitourinary prosthetic devices, implants and grafts, initialencounterStenosis of genitourinary prosthetic devices, implants and grafts, initialencounterThrombosis of genitourinary prosthetic devices, implants and grafts,initial encounterOther specified complication of genitourinary prosthetic devices,implants and grafts, initial encounterUnspecified complication of genitourinary prosthetic device, implantand graft, initial encounterEmbolism due to internal orthopedic prosthetic devices, implants andgrafts, initial encounterFibrosis due to internal orthopedic prosthetic devices, implants andgrafts, initial encounterDuplex Scan of Extracranial Arteries: Clinical Policy (Effective 11/01/2012)©1996-2012, Oxford Health Plans, LLC13
Page 1: CLINICAL POLICYDUPLEX SCAN OF EXTRA
Page 4 and 5: 433.81Occlusion and stenosis of oth
Page 6 and 7: G82.51 Quadriplegia, C1-C4 complete
Page 8 and 9: I60.7Nontraumatic subarachnoid hemo
Page 10 and 11: I65.29 Occlusion and stenosis of un
Page 14 and 15: T84.83XAHemorrhage due to internal

DUPLEX SCAN OF EXTRACRANIAL ARTERIES - Oxford Health Plans

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