Diagnosis: Thigh pain
Treatment: 93925 - Duplex scan, a special kind of picture of the lower extremity arteries (legs), Pre-service
The insurer denied the 93925 - Duplex scan, a special kind of picture of the lower extremity arteries (legs), Pre-service
The denial is overturned.

The patient is a female with complaints of thigh pain while walking. She has a history of deep vein thrombosis (DVT), smoking, pulmonary hypertension, inferior vena cava (IVC) filter, and morbid obesity. She has mildly depressed left ventricular (LV) function and heart failure with reduced ejection fraction (HFrEF).

Based on the patient's symptoms a duplex scan, (93925 - duplex scan, a special kind of picture of the lower extremity arteries [legs]) was ordered. It did indicate an abnormal ankle-brachial index (ABI). The ankle-brachial index showed mild distal ankle popliteal disease. Her ankle-brachial index was 0.91, bilaterally.

Yes, the proposed 93925 - duplex scan was medically necessary.
In a patient with these risk factors, in particular smoking and heart failure, it is appropriate to evaluate for peripheral artery disease causing low extremity symptoms. The least invasive and most valued procedure would be a Doppler examination to look for obstructive arterial disease. If result were negative, then it is unlikely that peripheral artery disease is the cause of her symptoms.