Primary Care Coding Alert

Question: Our provider screened a patient for peripheral artery disease (PAD) using bilateral ankle-brachial index (ABI) vascular tests in both the upper and lower extremities. The patient is a smoker who also has type 2 diabetes without complications, hyperlipidemia, and primary hypertension. We used 93922 with Z13.6 as the primary diagnosis, but got a denial from Humana. How should we correct our claim?

Codify Subscriber

Answer: There may be several problems here. First, your provider performed 93922 (Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries …) in both upper and lower extremities. As your provider tested both extremities, CPT^® notes direct you to report the procedure twice and attach modifier 59 (Distinct procedural service) to the second 93922. If you reported two units without attaching modifier 59, the payer may have denied one as a duplicate service.

Another problem may exist in using Z13.6 (Encounter for screening for cardiovascular disorders) as your primary diagnosis. On the surface, ICD-10 guidelines for screening codes seem contradictory, stating both that “a screening code may be a first-listed code if the reason for the visit is specifically the screening exam” and that “it may also be used as an additional code if the screening is done during an office visit for other health problems.”

If the screening was a part of an evaluation and management (E/M) encounter for the patient’s other conditions, this could be the reason for the denial, and the second guideline listed above would come into play. So, if the patient reported for diabetes, you would sequence the diagnoses first based on the reason for the encounter, such as E11.9 (Type 2 diabetes mellitus without complications), I10 (Essential (primary) hypertension), or E78.5 (Hyperlipidemia, unspecified) with the Z13.6 sequenced last.

Lastly, it may be that the payer does not cover 93922 as a screening service and only as a diagnostic tool. In that case, connecting diagnosis code Z13.6 to 93922, even as a secondary diagnosis, may result in a denial.

Whichever is the case, if the payer’s remittance advice does not indicate why the payer denied the service, make sure you follow up with the payer to clarify which of the above problems caused the denial.