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Medical Necessity

James Posted Mon 10th of March, 2014 19:55:19 PM

The doctor ordered an ultrasound ( outpatient in an office setting) 93880 (duplex scan of extracranial arteries. In his soap note he stated the patient may have carotid artery stenosis due to the presence of bilateral carotid bruits 443.10. Can I code 93980 with diagnosis code 433.10 to meet medical necessity? I'm questioning this because he said the patient my have carotid artery stenosis. I was under the impression that we could not code words like; rule out, possible, likely, questionable, may have...etc. Am I right with assuming this?

SuperCoder Answered Tue 11th of March, 2014 11:43:10 AM

No You cant.

Signs and symptom ICD-9 codes should be used to provide medical necessity for a procedure or service when there is not a more specific diagnosis available to the cardiologist. Although physicians are trained to look for a specific diagnosis, sometimes a patient may have a complaint that cannot be diagnosed right away.

In some cases, the complaint may be gone by the time the cardiologist evaluates the patient; in others, no definitive diagnosis can be ascertained before lab tests are returned.

In these situations and many others, signs and symptoms should be reported instead of suspected, or rule-out, diagnoses.

Code 785.9 for carotid bruits

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