Radiology Coding Alert

Adopt modifier indicator 1 when you report duplex and ablation codes.

Effective Oct. 1, 2015, the Correct Coding Initiative (CCI) introduced a change in modifier for edits bundling duplex scans with vein ablation. You can now earn for both services provided you know how to prove both services are distinct. Here is how the modifier indicators have changed for reporting these services.

The edits: CCI edits bundle 93971 (Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study) into 36475-36479 (Endovenous ablation therapy of incompetent vein, extremity …).

Until Oct. 1, 2015, these edits had a modifier indicator of 0, meaning you could never override the edit. Medicare and other payers applying the edit would reimburse you for the ablation, but not the duplex scan, if you reported both.

Starting Oct. 1, 2015, these edits have a modifier indicator of 1, so you may override the edits by appending a modifier to 93971 when you report it on the same claim and date of service as the ablation code.

Caution: The CPT^® instruction with 93971 still applies: “Do not report 93970, 93971 in conjunction with 36475, 36476, 36478, 36479.” Also note that you will still find a modifier indicator of 0 for edits bundling 93970 (Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study) into the ablation codes.

Translation: While you may report the unilateral or limited duplex scan and ablation on the same claim, you should do so only if the duplex scan is distinct from the ablation procedure.