Laura Posted Wed 09th of January, 2013 13:13:21 PM
Doctor is doing a Bilateral duplex venous scan and a bilateral vein mapping. Usually we would do a 93970 for them. In the report is says a thrombus is noted in the right popliteal vein extending into the upper tibal vein at the calf, The remainder of the veins in the right lower extremity shows normal compression, phasic flow and augmentation of the deep veins and saphenous vein in the left lower extremity.
The next report on the same day says....
Right Greater Saphenous vein is patent with no thrombus or thickened walls and measures .49cm promximally, .45 cm in upper thigh and .32 cm in mid thigh, .39 cm in distal thigh and .38 cm at the knee, .32 cm below knee and .31 cm in mid calf and .29 cm in distal calf. .. then it measures the left greater saphenous vein . Impression bilateral saphenous veins patent bilaterally
Suggestions for codes for both reports?
SuperCoder Answered Thu 10th of January, 2013 16:03:06 PM
Your question brings to mind three codes:
* 93970 Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study
* 93971 Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study
* G0365 Vessel mapping of vessels for hemodialysis access (services for preoperative vessel mapping prior to creation of hemodialysis access using an autogenous hemodialysis conduit, including arterial inflow and venous outflow)
Assuming the first service is a true complete bilateral duplex service, look at 93970. The second, assuming it’s for a bypass graft rather than for initial hemodialysis mapping, refers only to the saphenous vein, which looks more like limited code 93971 (93971 can be used for bilateral services that are limited). CCI edits require a modifier on 93971 (assuming separate session) to override the edit with 93970.
The question is medical necessity. Why is the patient given two separate sessions for these similar exams? Why wasn’t the saphenous vessel mapping performed during the complete duplex? Will documentation support reporting both services on the same date? Reporting complete and limited codes on the same date will raise questions for the payer.
Be sure to review the LCD for the codes to see what information it has on coding and medical necessity. For instance, Novitas includes this info: “Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study (CPT code 93971) is indicated for the preoperative examination of potential harvest vein grafts to be utilized during bypass surgery. This is a covered service only when the results of the study are necessary to locate suitable graft vessels. The need for bypass surgery must be determined prior to performance of the test. Only one preoperative scan is covered for bypass surgery.”
You also may find this ACR Coding Source article helpful: http://gm.acr.org/Hidden/Economics/FeaturedCategories/Pubs/coding_source/archives/January-February2007/NoninvasiveVascularDiagnosticStudiesDoc6.aspx