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Code 93975

Stephnaie Posted Tue 22nd of October, 2013 08:39:02 AM

How do you bill 76775-26 and 93975-26? What modifiers and where?

SuperCoder Answered Wed 23rd of October, 2013 05:16:35 AM

76775 > Ultrasound, retroperitoneal (e.g., renal, aorta, nodes), real time with image documentation; limited
93975 > Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; complete study

Ultrasound and duplex examinations of the same visceral anatomy as indicated above are not separately reportable unless they are medically necessary and reasonably performed in the same clinical scenario. If both examinations have their individual documentations reports containing descriptions of the elements visualized and recorded imaging reports to support their individual medical necessity, then they could be billed as follows:

93975-26
76775-59,26

At times, duplex scan is performed only for anatomic structure identification in conjunction with real-time ultrasound and does not involve production of a hard copy or real-time images in output record allowing analysis of bidirectional vascular flow. In this scenario, the duplex scan is not separately reportable with real-time ultrasound services,i.e., only 76775 would be reportable.

Stephnaie Posted Mon 04th of November, 2013 18:11:31 PM

Can you tell me what is the primary code when billing 93975 with any other abdominal ultrasound (pelvic, renal, RUQ, aortic). Is it based off RVU?

Stephnaie Posted Thu 07th of November, 2013 09:55:19 AM

Can you tell me what is the primary code when billing 93975 with any other abdominal ultrasound (pelvic, renal, RUQ, aortic). Is it based off RVU?

SuperCoder Answered Thu 07th of November, 2013 10:22:54 AM

The primary code when billing 93975 with other abdominal region ultrasound codes is 93975 itself as the other ultrasound codes are column 2 codes for 93975 according to CCI edits.

Apologise for the delay in response.
Thanks.

Stephnaie Posted Thu 21st of November, 2013 17:57:50 PM

So sorry for beating this dead horse... but, we are a huge billing company that bills radiology and cant' get clear on this. When we researched the 93975 on the American College of Radiology, this is the example they gave, which seems to be a different answer than what we got here. I thought you said we would code the ultrasound with the 59, not the duplex (93975/93976)

"For example, a patient comes in with pelvic pain, and the ultrasound of the pelvis demonstrates an enlarged ovary. The differential diagnosis includes torsion of the ovary. A vascular study is requested to establish the arterial inflow and venous drainage of the ovary and determine torsion or infarction. In this scenario, it would be appropriate to code 76856 for the pelvic ultrasound and 93976-59 for the limited vascular study of the ovary."

SuperCoder Answered Fri 22nd of November, 2013 08:10:56 AM

The horse isn't dead until you say so....I was able to locate this article that you are referring to and it turns out that the article refers to Question/answer sessions from July-August 2009. I would like to refer to the complete excerpt as found on the article as below:

"Note that since January 1997, Medicare Correct Coding Initiative (CCI) edits have been in place for the vascular study codes (93975/93976) when used in conjunction with the pelvic ultrasound codes (76856/76857). Medicare considers these pairs to be mutually exclusive—that is, they should not be performed by the same physician, for the same patient, on the same date of service. The code pair edits do list a modifier indicator of "1" with the vascular study codes (939751,939761); therefore, it would be appropriate to submit these codes together with a modifier attached to the vascular study code (e.g., 93975–59 or 93976–59). For example, a patient comes in with pelvic pain, and the ultrasound of the pelvis demonstrates an enlarged ovary. The differential diagnosis includes torsion of the ovary. A vascular study is requested to establish the arterial inflow and venous drainage of the ovary and determine torsion or infarction. In this scenario, it would be appropriate to code 76856 for the pelvic ultrasound and 93976-59 for the limited vascular study of the ovary."

With regard to the "mutually exclusive" edits being referred to, kindly refer to the following information on the CMS website (CMS maintains and quarterly updates these edits):

"Effective April 1, 2012, CMS will no longer publish a Mutually Exclusive edit file on its website for either practitioner or outpatient hospital services since all active and deleted edits will appear in the single Column One/Column Two Correct Coding edit file on each website. The edits previously contained in the Mutually Exclusive edit file are NOT being deleted but are being moved to the Column One/Column Two Correct Coding edit file."

Now, moving forward from here, I had referred to the latest update on CCI edits, namely version 19.3 effective October 1, 2013. This update shows 93975 as column 1 code and 76775 as the column 2 code with an indicator 1 against the edit pair showing that a modifier is allowed to override this edit. A column 1 code is often a more comprehensive code and column 2 code a component code and NCCI-associate modifier (such as 59) is used against column 2 code to report these two codes together under appropriate circumstances. Also according to NCCI policy manual, Chapter 9, Section H.13 on IX-20 following statement confirms that 76775 should be reported with 59 modifier:

"Abdominal ultrasound examinations (CPT codes 76700-76775) and abdominal duplex examinations (CPT codes 93975, 93976) are generally performed for different clinical scenarios although there are some instances where both types of procedures are medically reasonable and necessary. In the latter case, the abdominal ultrasound procedure CPT code should be reported with an NCCI-associated modifier."

I hope I have reasonably answered your query with these citations.
Thanks!

Stephnaie Posted Fri 22nd of November, 2013 10:28:05 AM

Yea!! Thanks. Also, just to confirm... did you mean in this statement that a column ONE code is often a more comprehensive code?

A column 2 code is often a more comprehensive code and column 2 code a component code and NCCI-associate modifier (such as 59) is used against column 2 code to report these two codes together under appropriate circumstances.

SuperCoder Answered Fri 22nd of November, 2013 10:48:08 AM

Yes, a column 1 code is often a more comprehensive code and column 2 code is a component code to column 1 code. My impression is that the most important information that you need is the one from NCCI policy manual, Chapter 9, section H.13.
Thanks.

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