# The Bilateral Vascular Debate...Please help.



## Belinda Frisch (Apr 28, 2010)

I am in need of some opinions/information on 93926 (duplex scan of LE; unilateral OR limited). 

The following is an excerpt from an SIU from our Medicare carrier NGS:

"The following services are by definition limited or unilateral studies and should also be billed only with a number of services of one (1): 93882, 93888, 93890, 93892, 93893, 93926, 93931, 93971, 93976, and 93979.
A bilateral modifier (50) is not appropriate with these codes. Bilateral or complete studies should be reported with the appropriate codes, but with only one (1) unit of service. The appropriate anatomic modifier should be
appended to the unilateral procedure codes."

According to this, as I interpret it, bilateral studies should not be coded using 93926. 

We recently had a patient with multiple vascular studies on the same day and 93926 was marked (along with 93923 and 93880). When I tried to ascertain LT or RT (consistent with the anatomic modifier requirement above), I was told it was a bilateral study that was "limited" (included: external iliac, common, proximal, and superficial femorals w/ PVR)which started the discussion. 

First question is: does anyone have documentation of what is a "complete" bilateral study (93925)?

Second: what is your interpretation of the above and/or practice for coding this scenario? Specifically, do you think 93926 should be used to bill a "limited" BILATERAL study?

Thanks all for taking the time to answer.


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## Belinda Frisch (Apr 28, 2010)

*Found the answer*

http://www.acr.org/Hidden/Economics...NoninvasiveVascularDiagnosticStudiesDoc6.aspx

Since there has been views on this post, I thought I'd share the answer: 

"A few questions commonly occur when coding for noninvasive vascular scans of the extremities. If a limited bilateral study is performed, the code used should be the “unilateral or limited study” codes (93926, 93931, 93971). These codes are not just for a unilateral, or limited unilateral study, but encompass a bilateral study, which is otherwise limited, as opposed to complete.4 The physiologic study codes state “upper or lower extremity,” making it appropriate, when both upper and lower extremities are studied, to report the code twice."

I am thinking that NGS policy is more referring to not billing a quantity of 2 rather than using a different code for bilateral studies.


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## nelsong5 (Oct 7, 2010)

A complete bilateral study is a Duplex Scan of the Arteries of the Lower Extremities (93925).

A Duplex Study needs to include imaging of the arteries with color flow (plus measurements etc). Your techs should know what that means.

Then, your reading doctor should put on his report that it is a DUPLEX Scan of the Lower Extremities Arteries.

If you do that you are covered to bill 93925, of course the referring providers medical necessity should justify the study as well. 

A 93926 is the same thing i said above but ONLY of one lower extremity (RT or LT)

Now since you billed a 93923 alongside the 93926 you are contradicting yourself because a 93923 is a BILATERAL Study of the Lower Extremities Arteries with DOPPLER (Not Duplex) and the 93926 is what i mentioned earlier emphasizing that is a UNILATERAL DUPLEX Study. 

This is a bit complicated to explain on a forum, but you have any further questions message me and i will give you my cell phone number to be more clear about it.


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## TamaraM (Jun 13, 2011)

93925 Complete bi study:
The scan must include full length of:
common femoral art, superficial art, & popliteal arteries.
Blood pressure/systolic should be included.

If indicated by pt's sym the iliac, deep femoral and tibioperoneal arteries should be included.  93925also includes arterial bypass w/in lower ext including surronding/adj vessels

93926 is coded for a LIMITED, unilateral, or follow study. (can be used for a limited bilateral study)


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## asteele813 (Mar 7, 2012)

*what if you see this?*

If I have an Arterial Doppler Bilateral, that in the finding it states Popliteal and PTA not seen. Is this considered Limited? If this is limited, would you use 93925-52 or 93926?

If you have a patient that has amputaion (BKA/AKA), would you code that as limited? or Complete?

Thanks for your help!


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