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Having denial for peripheral '93923 & 93925' and '93965 & 93970'.

Noami Posted Tue 29th of January, 2013 00:55:14 AM

'93923 & 93925'
'93965 & 93970'

SuperCoder Answered Tue 29th of January, 2013 14:42:42 PM

CPT codes 93922, 93923 and 93965 are complete bilateral studies. When the service is performed unilaterally, submit CPT modifier 52 (reduced services) and indicate 'unilateral' in the documentation record for electronic claims or as an attachment to the CMS-1500 claim form.
Duplex post-interventional follow-up studies are usually limited in scope and unilateral in nature; therefore, the 'unilateral or limited study' codes should typically be used

A quantity of 'one' must be used for a study of one anatomic area as described in the code definition
The physiologic study will be denied as not medically necessary when CPT codes 93922 through 93923 and CPT codes 93925 through 93931 are submitted for the same date of service
To document that it was medically necessary to perform both physiologic and duplex extremity examinations on the same day, both services must be submitted on the same claim and the claim must be submitted with one of the following ICD-9 codes: 442.0, 442.3, 442.82, 444.21, 444.22, 794.30, 903.00 through 904.9 or V58.73
To document that it was medically necessary to perform venous duplex (CPT code 93970 or 93971) as surveillance of a patient at high risk for DVT due to immobility, trauma or surgical procedure, the service must be submitted with one of the following ICD-9 codes: V12.51, V12.52, V45.1, V45.81, V45.89, V67.00, V58.9 or V49.84

Advance Beneficiary Notice (ABN) Information
If the service being performed is not covered under the LCD guidelines, we encourage you to provide your patients with an ABN prior to performing these tests
ABNs allow patients to make an informed decision about whether to receive a service that is likely to be non-covered on the basis of 'not reasonable and medically necessary'
If you utilize ABNs, they must be issued in advance. Maintain the original in the patient's medical record. Provide the patient with a copy of the signed notice.

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