What is the CPT (Current Procedural Terminology) code for a carotid ultrasound?

CPT Codes for Carotid Ultrasound

The primary CPT code for a standard carotid ultrasound is 93880 for bilateral carotid artery examination and 93882 for unilateral examination.

Understanding Carotid Ultrasound CPT Codes

Carotid ultrasound is a safe, noninvasive, and cost-effective screening technique for imaging the carotid bifurcation and measuring blood velocities 1. The appropriate CPT code depends on whether the examination is performed on one or both sides:

• 93880: Duplex scan of extracranial arteries; complete bilateral study
• 93882: Duplex scan of extracranial arteries; unilateral or limited study

Clinical Applications and Coding Considerations

Carotid ultrasound is commonly used for:

1. Screening for carotid stenosis: Particularly in asymptomatic patients with carotid bruits 1
2. Initial evaluation of patients with suspected TIA or stroke: Guidelines recommend duplex ultrasonography to detect carotid stenosis in patients who develop focal neurological symptoms corresponding to the territory supplied by the left or right internal carotid artery 1
3. Monitoring known carotid disease: For surveillance of previously identified stenosis

Technical Components of the Examination

The examination typically includes:

• B-mode imaging of the carotid arteries
• Color Doppler assessment
• Spectral Doppler analysis including:
  • Internal carotid artery peak systolic velocity
  • End-diastolic velocity
  • Ratios of internal carotid artery and common carotid artery peak systolic velocity 1

Anatomical Coverage

A complete carotid ultrasound examination includes assessment of:

• Common carotid artery (typically 10 mm below the bulb)
• Carotid bifurcation
• Internal carotid artery (typically 10 mm above the flow divider)
• External carotid artery 1

Limitations and Alternative Imaging

While carotid ultrasound is an excellent first-line test, it has some limitations:

• Limited ability to image extracranial vasculature proximal or distal to the bifurcation 1
• Sensitivity and specificity for detecting lesions >70% are in the range of 83-86% for sensitivity and 87-99% for specificity 1

When carotid ultrasound results are equivocal or indeterminate, additional imaging may be required:

• CT angiography (CTA)
• MR angiography (MRA)
• Digital subtraction angiography (DSA) in select cases 1

Coding Pitfalls to Avoid

1. Don't confuse with transcranial Doppler codes: Transcranial Doppler uses different CPT codes (93886,93888)
2. Don't use intracranial codes: Carotid ultrasound examines extracranial vessels
3. Document medical necessity: Ensure appropriate documentation of symptoms or risk factors that justify the examination

By using the correct CPT code (93880 for bilateral or 93882 for unilateral studies), providers can ensure proper reimbursement while providing this valuable diagnostic service to patients with suspected carotid artery disease.