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Duplex Doppler

Eunice Posted Mon 19th of March, 2012 15:50:35 PM

Is anyone using CPT 93998 (Unlisted noninvasive vascular diagnostic study)?
We performed breast ultrasound and duplex color doppler and spectral doppler images but there isn't specific CPT for duplex color doppler and spectral doppler images of the breast, so we are using 93998 because CPT 93975/93976 is for duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs. Does anyone know if insurance reimburse 93998?

Thank you!

SuperCoder Answered Tue 20th of March, 2012 05:43:10 AM

Not sure if it's the correct code. But insurance will not reimburse for an unlisted code unless you follow certain procedures. 1) You need to compare this code with another listed CPT code whose procedure description is nearer to the service which you are billing for. You need to tally this to claim the specific $$ amounts. By nature, unlisted codes do not have any specific payment under MPFS. So in your claim, you need to compare another CPT code and its payment with code 93998, and then charge that $$ amount.
2) You need to submit doctor's documentations + a cover letter explaining the reason why you have billed an unlisted code and why you are charging that particular $$ amount.

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