Radiology Coding Alert

Question: When I report 93880, may I report 93875 and 93886, too, if the physician performs all three? And when I report 93970, may I also report 93965? Or are these services bundled?

Pennsylvania Subscriber

Answer: Although Correct Coding Initiative (CCI) edits don't bundle the code combinations you mention, that doesn't mean payers will consider performing the services together medically necessary.

Case in point: Highmark, Pennsylvania's Medicare contractor, published local coverage determination (LCD) L27504, "Non-Invasive Cerebrovascular Arterial Studies." The LCD states that "it is usually unnecessary to perform more than one type of physiological study on the same anatomic area." If the radiologist must perform a second test because the first isn't interpretable, the LCD instructs you to report only the successful test.

Also, Highmark will rarely reimburse 93875 (Noninvasive physiologic studies of extracranial arteries, complete bilateral study [e.g., periorbital flow direction with arterial compression, ocular pneumoplethysmography,  Doppler ultrasound spectral analysis]), the LCD states. The expectation is that the radiologist would perform the duplex scan (93880, Duplex scan of extracranial arteries; complete bilateral study) as the initial service because it has a higher accuracy rate.

Watch for: You may report the codes together if the case meets the payer's medical necessity requirements, however. For example, "physiologic studies and a duplex scan performed on the same day will be considered medically necessary if there is a 50 percent stenosis demonstrated on the duplex scan, or there are significant symptoms present," the LCD states.

Resources: Highmark LCD L27506 (www.highmarkmedicareservices.com/policy/mac-ab/l27506-r5.html) discusses 93965 (Noninvasive physiologic studies of extremity veins, complete bilateral study [e.g., Doppler waveform analysis with responses to compression and other maneuvers, phleborheography, impedance plethysmography]) and 93970 (Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study).

LCD L27504 (www.highmarkmedicareservices.com/policy/mac-ab/l27504-r6.html) discusses 93875, 93880, and 93886 (Transcranial Doppler study of the intracranial arteries; complete study).

-- The answers for You Be the Coder and Reader Questions were reviewed by Michele Midkiff, CPC-I, PCS, RCC, executive director of Coding Affiliates Inc., an interventional and neuro-interventional radiology coding service in Mountain View, Calif.