# 93970 with 93971



## maine4me (Dec 19, 2011)

I am new to vascular coding and need help with this issue.  There is a vascular surgeon at our surgical practice, however his billing and coding is being done by a outside billing company.  I have a RAC audit, because the services were billed as 93970 - 26 and 93971 - 26.  I think based on the following note we should have only billed the 93970.

Duplex imaging of the right internal jugular, subclavian, axillary, and brachial veins reveals no evidence of echogenic material within the vein.  Compression reveals good approximation of opposing vein walls.  Augmentation is normal.  Cephalic vein is not visualized.  Basilic vein is and there is no evidence of superficial phlebitis.

Duplex imaging of the left internal jugular, subclavian, axillary, and brachial veins reveals no evidence of echogenic material within the vein.  Compression reveals good approximation of opposing vein walls.  Augmentation is normal. 

This all there is for the description of the procedure.  Now, maybe I am wrong, but I do not think the 26 modifier is appropriate in this case either.  

Thanks for the help.


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## Joe_coder07 (Dec 20, 2011)

Hi,

This should be coded with 93970-26 please gothrough the below guideline to code duplex,

1. Technique
Upper extremity duplex evaluation consists of grayscale and Doppler assessment of all the accessible portions of the subclavian, innominate, internal jugular, and axillary veins, as well as compression grayscale ultrasound of the brachial, basilic, and cephalic veins in the upper arm to the elbow. All accessible veins should be scanned using optimal grayscale and Doppler techniques as well as appropriate positioning. Venous compression is applied to accessible veins in the transverse plane with adequate pressure on the skin to completely obliterate the normal vein lumen.
Symptomatic areas, such as the forearm, may require additional evaluation, if the cause of the symptoms is not already elucidated by the standard examination.
2. Recording
a. For each normal examinations, at a minimum:
i. Grayscale images should be recorded without and with compression at each of the following levels:
a. Internal jugular vein.
b. Peripheral subclavian vein.
PRACTICE GUIDELINE Peripheral Venous Ultrasound / 3
c. Axillary vein.
d. Brachial vein in the arm.
e. Cephalic vein in the arm.
f. Basilic vein in the arm.
g. Focal symptomatic areas, if present.
ii. Color images are recorded at each of the following levels using appropriate color technique to demonstrate filling of the normal venous lumen:
a. Internal jugular vein.
b. Subclavian vein.
c. Axillary vein.
d. If seen, the innominate vein should be recorded with color Doppler.
iii. At a minimum (even if the examination is otherwise unilateral), the right and left subclavian venous spectral Doppler waveforms should be recorded to evaluate for asymmetry or loss of cardiovascular pulsatility and respiratory phasicity. All spectral Doppler should be obtained from the long axis.
a. Right subclavian vein.
b. Left subclavian vein (from same location in the vein and in same patient position as the right one).
b. Abnormal examinations generally require additional images. The extent and location of sites where the veins fail to compress or fill with color completely should be clearly recorded and generally require additional images. Long axis views without compression may be helpful to characterize the abnormal vein.
c. The patient presentation, clinical indication, or clinical management pathways may require protocol adjustments such as imaging the forearm veins or performing a bilateral study [11-13].
d. Other vascular and nonvascular abnormalities, if found, should be recorded, but may require additional imaging for diagnosis or further characterization.

Regds,


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## donnajrichmond (Dec 20, 2011)

maine4me said:


> I am new to vascular coding and need help with this issue.  There is a vascular surgeon at our surgical practice, however his billing and coding is being done by a outside billing company.  I have a RAC audit, because the services were billed as 93970 - 26 and 93971 - 26.  I think based on the following note we should have only billed the 93970.
> 
> Duplex imaging of the right internal jugular, subclavian, axillary, and brachial veins reveals no evidence of echogenic material within the vein.  Compression reveals good approximation of opposing vein walls.  Augmentation is normal.  Cephalic vein is not visualized.  Basilic vein is and there is no evidence of superficial phlebitis.
> 
> ...



You would add modifier -26 if he is billing for the interpretation only (such as when the exam was performed at the hospital.)  If this is being done in his office, on equipment he owns, and with his staff and he is billing globally then modifier -26 would not be added. 

This is one exam, 2 codes would not be appropriate.  

However, there is a bigger problem here.  He says this is a "duplex" scan, but there is no mention of either spectral or color doppler.  Both are required for duplex scanning.  Without color doppler and spectral analysis this would be 76882.


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## RADCODER (Dec 27, 2011)

Agreed with Donna.. for further clarification (in case your surgeon is requesting documentation), follow this link from the ACR.

http://www.acr.org/Hidden/Economics...eVascularDiagnosticStudiesDoc6.aspx?css=print

Good Luck!


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## amymeyers01 (Mar 9, 2012)

*93970 w/missing element*

I know that this is an older post; however, I am just now running into a problem because I am working for a billing company that doesn't allow reports to be returned for addendums and we have no contact with the radiologists.  We are supposed to downcode any reports that don't meet documentation requirements for the titled study.  For an extremity venous Duplex exam, what do you downcode to if you are missing spectral analysis only?  The report obviously has imaging and it has color Doppler flow - so it doesn't fit with a noninvasive study either.  

I fully understand the requirements and definitions, but no one seems to state how to deal with one missing element.  The ACR article is great for someone who needs to understand what all the terminology means so they know what to look for, but they also don't address missing elements in documentation.  Do you just downcode a bilateral to a 93971?  What if it is already a limited/unilateral study - do you use a -52 modifier? Any help - and preferably authoritative guidance - would be appreciated.

Thanks!!


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