Annie Posted 5 month(s) ago
Is there any certain criteria to meet in order to bill this code? Also, does a separate report of findings need to be dictated by physician in order to be billed.
Annie Posted 5 month(s) ago
I am asking about the code 93970.
SuperCoder Posted 5 month(s) ago
Duplex scanning of arteries for the evaluation of blood flow is a type of non–invasive vascular diagnostic process. A physician can visualize and selectively assess the flow patterns of peripheral vessels using real–time ultrasound imaging and pulsed Doppler. The presence of arterial stenosis, occlusion and identification of incompetent veins can also be achieved through this process.
The physician or a technician performs the duplex scanning procedure by holding a probe on the skin surface. The probe emits short ultrasonic pulses which travel into the body. When the ultrasound pulse collides with a soft tissue, it gets reflected and arrives back to the probe as an echo. Echoes from stationary structures come back to the probe with the same frequency, but in moving targets, echoes return with a higher or lower frequency. The scanner can detect even minute changes in frequency and can calculate the speed and direction of blood flow. Successive pulses from the probe and echoes generated through the body together create an image of a targeted plane in the body. The physician also performs some maneuvers such as compression and other tests to observe changes in the flow inside the vessels. During this procedure, the physician may examine the vascular flow of both sides of the extremities.
Yes, a report of findings need to be dictated by physician to bill the code.
1. Question: Can you bill a bilateral scan (93970) along with an office visit and get paid for both? Would you need to use modifier 25 on the office visit?
Answer: You may report an E/M service and 93970 (Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study) on the same claim. Whether you need to append modifier 25 may depend on your payer.
Explanation: The global period for 93970 is XXX, according to the Medicare physician fee schedule. Medicare's Correct Coding Initiative (CCI) manual, chapter 1, section D, states that if you have a truly separate E/M, you may report it on the same day as a XXX procedure. The manual goes on to say that you should append modifier 25 to the E/M code. (As mentioned above, different payers may have different requirements for use of modifier 25, particularly because you won't find E/M codes bundled with 93970 in the listed CCI edit pairs.)
Take care: The CCI manual sets out the following rules:
You should not report a separate E/M code for the usual pre–, intra–, and post–procedure work expected from a physician for the given XXX procedure. You should not report a separate E/M code to represent physician supervision or interpretation of another provider's performance of a XXX procedure that has no physician work relative value units (RVUs).
Bonus tip: If both bilateral upper and lower studies are performed on the same date and/or session, code 93970 twice and append modifier 59 to one of the codes.
2. Question: If we perform a duplex scan of both upper extremities and of both lower extremities, can we enter 93970 twice with a modifier 59?
Answer: Experts agree that when complete bilateral upper and complete bilateral lower studies are performed on the same date, you may report 93970 (Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study) two times with modifier 59 appended to the second code.
For authoritative support, check your payer's policy.
For example: Highmark Medicare's policy states, "If a complete or limited bilateral study is done on both the upper and the lower extremities, the corresponding code can be reported once for each study performed (i.e., once for the upper extremities and once for the lower extremities). Providers should append modifier 59, distinct procedural service, to the second code to indicate that two separate, distinct studies were performed."
Additionally, Highmark states, "There should be a separate written report/interpretation for each study performed."
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