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Joe Posted Fri 11th of November, 2011 19:15:11 PM

93976 is column 2 to 76856. When coding together, I will append 59 to 93976. However, would 789.00 alone on 93976 get it paid? In otherwords, what would justify me separating 93976 from 76856?


SuperCoder Answered Sat 12th of November, 2011 18:54:37 PM

789.00 will not help get 93976 paid. In other words it is justifying that even though to some extent the anatomical region and the method of study (ultrasound) is similar, but the purpose of study is different. In 93976 the study is of arterial and venous blood flow abnormalities, which is not the same in case of 76856.

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 (93975,93976); 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.

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