Radiology Coding Alert

Master 'complete' and 'limited' to end this costly mistake

If you’ve ever faced the question of whether you can report a duplex scan and ultrasound together, you’re in luck. Our experts reveal what you need to know to code limited and complete visceral and penile vascular studies.

The procedure: A duplex scan is a noninvasive vascular diagnostic study--an ultrasonic scanning procedure display of the following:

• the two-dimensional structure of the target analysis and the vessels’ motion with time
• the Doppler ultrasonic signal of the flowing blood.

You need full documentation of these anatomic and physiologic parameters to report these codes.

The documentation should also include a spectrum analysis and/or color flow mapping or imaging of the flowing blood, says Cynthia A. Swanson, RN, CPC, senior consultant for Seim, Johnson, Sestak & Quist LLP, in Omaha, Neb.

The duplex scan codes specific to visceral and penile vascular studies are in the 90000 section of the CPT manual, says Stacie L. Buck, RHIA, LHRM, vice president of Southeast Radiology Management:

• 93975--Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; complete study

• 93976--… limited study

• 93978--Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; complete study

• 93979--… unilateral or limited study

• 93980--Duplex scan of arterial inflow and venous outflow of penile vessels; complete study

• 93981--… follow-up or limited study.

Cut Out Missed Opportunities to Code ‘Complete’

You should assign a “limited” code, such as 93976, when the documentation describes imaging only a portion of the code descriptor’s components.

Example: The radiologist imaged the blood flow of only a specific portion of a single abdominal organ. Report 93976.

The beginning of the descriptor for 93975 and 93976 states “and/or,” so you don’t have to report a limited code just because the physician didn’t study all of the anatomic areas in the descriptor. A complete abdominal study, without mention of the other anatomic areas, may still merit complete code 93975.

But for the “complete” procedure, you must see evaluation of all major vessels supplying blood flow (inflow and outflow, with or without color flow mapping) to the target organ, Buck says.

Note: You don’t have to choose a limited code if despite best efforts (described in detail in the imaging report) the physician can’t visualize the target vessels, perhaps because of overlying or intervening structures or altered surgical anatomy.

Make Room for US Code, if Medically Necessary

You shouldn’t assign a code for a duplex scan in conjunction with a conventional gray-scale ultrasound (US) unless the duplex exam is medically necessary and you have adequate documentation of both, Buck says. “For non-hospital patients, there is a third consideration--there should be an order for both exams,” she adds.
 
Example: The American College of Radiology suggests that if the radiologist performs a vascular study (with or without color Doppler) and US of the liver, you may report both 76705 (Ultrasound, abdominal, B-scan and/or real time with image documentation; limited) and 93975 if both are medically necessary, Buck says. And of course you must have the appropriate orders.

You may see these studies when the radiologist would like to enhance a suspect area or needs the duplex scan for more detailed analysis.

Dodge These Documentation Traps

Physicians don’t routinely perform duplex scans in conjunction with US exams, so be wary of reporting the two together routinely.

Caution: If the radiologist reports “flow visualized” or “flow good,” that’s not enough to justify assigning a code for a duplex scan in addition to a regular US code, Buck says. You also shouldn’t code a duplex scan “when color is just turned on to determine if a structure is vascular,” such as to distinguish the hepatic artery from the common bile duct, she says.

What to look for: A duplex scan interpretation should clearly address the movement of blood through the imaged vessels, Buck says. “For example, some of the code descriptions [93975, 93976, 93980, 93981] state ‘arterial inflow and venous outflow,’ ” she says. You must find evidence in the report that the radiologist examined both and recorded the flow.