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Exam Requirements: Vascular Ultrasound (Revised 11-9-2022)

Revision History



The Vascular module includes the following submodules:

  • Peripheral Arterial

  • Peripheral Venous

  • Cerebrovascular

  • Liver Vasculature

  • Renal Vasculature

  • Aorta

Sites must apply for all submodules performed. If only one submodule is performed, two examinations are required for that submodule. If two or more submodules are performed, one examination from each submodule performed is required. 


Complete documentation/survey means a series of several images throughout the entire organ in two planes. For example, from one side of the organ to the other in the longitudinal plane and from superior to inferior in the transverse plane. 


Anatomy should be intentionally imaged in an organized fashion and correctly labeled for clarity.




Exam Requirements: Peripheral Arterial

Lower Extremities - Arterial Duplex

*A bilateral exam should be submitted


Longitudinal gray scale images 

  • Common femoral artery

  • Proximal profunda femoris artery

  • Superficial femoral artery - proximal, mid, and distal

  • Popliteal artery - proximal and distal

  • Anterior tibial artery

  • Posterior tibial artery - distal 

  • Dorsalis pedis artery


Longitudinal stand-alone color Doppler images

  • Common femoral artery

  • Proximal profunda femoris artery

  • Superficial femoral artery - proximal, mid, and distal

  • Popliteal artery - proximal and distal

  • Anterior tibial artery

  • Posterior tibial artery - distal

  • Dorsalis pedis artery


Longitudinal spectral Doppler waveform with color Doppler evaluation

  • Common femoral artery

  • Proximal profunda femoris artery

  • Superficial femoral artery - proximal, mid, and distal

  • Popliteal artery - proximal and distal

  • Anterior tibial artery

  • Posterior tibial artery - distal

  • Dorsalis pedis artery



Exam Requirements: Peripheral Venous

Lower Extremities - Venous

Lower Extremities - Venous Insufficiency

A bilateral exam should be submitted


Static transverse gray scale images without and with compression OR transverse gray scale cine clips without and with compression

  • Common femoral vein - superior to and separate from the saphenofemoral junction

  • Saphenofemoral junction

  • Proximal profunda femoris vein

  • Femoral vein – proximal, mid, and distal

  • Popliteal vein


Longitudinal color and/or spectral Doppler waveform images

  • Saphenofemoral junction

  • Proximal profunda femoris vein

  • Femoral vein – proximal, mid, and distal


Spectral Doppler waveform demonstrating spontaneous flow and respiratory phasicity

  • Common femoral vein or external iliac vein

  • Popliteal vein

Static transverse gray scale images without and with compression OR transverse gray scale cine clips without and with compression. 

  • Common femoral vein - superior to and separate from the saphenofemoral junction

  • Saphenofemoral junction

  • Proximal profunda femoris vein

  • Femoral vein - proximal, mid, and distal

  • Popliteal vein


Documentation of direction of flow with color and spectral Doppler waveform following augmentation maneuvers or Valsalva (in the upper thigh) with the patient in the semi-upright or upright position. Length of time of reflux must be measured in at least one location within the superficial system.

  • Common femoral vein

  • Saphenofemoral junction

  • Proximal profunda femoris vein

  • Femoral vein - proximal, mid, and distal

  • Popliteal vein

  • Great saphenous vein including saphenofemoral junction and throughout thigh at a minimum

  • Inferior to knee

    • Great saphenous vein - below the knee

    • Small saphenous vein


Exam Requirements: Cerebrovascular

Extracranial Carotid

Transverse gray scale images

  • Common carotid artery – proximal and distal

  • Bifurcation

Longitudinal gray scale images

  • Common carotid artery – proximal and distal

  • Internal carotid artery – proximal

  • External carotid artery – proximal

Longitudinal stand-alone color Doppler images

  • Common carotid artery – proximal and distal

  • Internal carotid artery – proximal

  • External carotid artery – proximal

Longitudinal spectral Doppler waveform with color Doppler evaluation

  • Common carotid artery – proximal and distal

  • Internal carotid artery – proximal, mid, and distal 

  • External carotid artery – proximal

  • Vertebral artery



Exam Requirements: Liver Vasculature

Complete gray scale documentation in longitudinal

  • At least three gray scale images of the left lobe to include lateral, mid, medial

  • At least three gray scale images of the right lobe to include lateral, mid, medial  

Complete gray scale documentation in transverse

  • At least three gray scale images of the left lobe to include superior, mid, inferior

  • At least three gray scale images of the right lobe to include superior, mid, inferior

Gray scale images of vascular anatomy including vessel labeling

  • Portal veins – main, right, and left

  • Hepatic veins – right, middle, and left

  • Inferior vena cava

  • Splenic vein – posterior to pancreas

Color or power Doppler images

  • Portal veins - main, right, and left

  • Hepatic veins – right, middle, and left

  • Hepatic artery

  • Inferior vena cava

  • Splenic vein - posterior to pancreas

Spectral Doppler waveform images

  • Portal veins – main (angle correction required), right, and left

  • Hepatic veins - right, middle, and left

  • Hepatic artery (angle correction required)

  • Inferior vena cava

  • Splenic vein – posterior to pancreas



Exam Requirements: Renal Vasculature

Renal Artery Stenosis

*Both kidneys MUST be present


Complete gray scale documentation of kidneys in longitudinal 

  • At least three gray scale images to include lateral, mid without measurement, medial


Complete gray scale documentation of kidneys in transverse 

  • At least three gray scale images to include upper pole, mid without measurement, lower pole


Renal length


Spectral Doppler waveform images

  • Aorta (angle correction required) - at or just above the origin of the renal arteries

  • Main renal artery (angle correction required) - proximal, mid, and distal

  • Main renal vein

  • Upper and lower pole segmental or interlobar arteries documenting RI or AI/AT



Exam Requirements: Aorta

Longitudinal gray scale images without and with AP measurements

  • Aorta – proximal, mid, and distal

  • Right common iliac artery

  • Left common iliac artery

Transverse gray scale images without and with transverse measurements

  • Aorta – proximal, mid, and distal

  • Proximal common iliac arteries

Color and/or spectral Doppler waveform of the distal aorta




Revision History for this Article
Date
Section
Description of Revision(s)
12-12-19
All
Article created; FAQs incorporated; No criteria changes
3-13-2020
Diagnostic Criteria
The submission of diagnostic criteria has been removed and is no longer required.
6-2-2020

Added complete documentation description
8-4-2020
Exam Requirements: Abdominal Ultrasound
Additional documentation clarification for liver vasculature, liver transplantation, TIPS, renal artery stenosis, renal vein thrombosis and renal transplant (renal artery thrombosis) exams.
10-15-2020

Removed and/or after abdominal (Liver or Renal) for clarification purposes
10-30-2020
Liver Vasculature
Changed main portal vein to portal veins- main, right and left
2-16-21
Aorta
longitudinal gray scale images without and with AP measurements and transverse gray scale images without and with transverse measurements
4-20-21
Renal Transplant (Renal Artery Thrombosis)
Changed kidneys to transplanted kidney
1-21-2022

Updated exam requirements
5-10-2022
Thrombosis- Upper Extremities
Aligned all bullets under transverse gray scale without and with compression
11-9-2022
All
Updated exam requirements



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