Radiology Coding Alert

Question: We've been getting denials when we report 93978 and 76700 on the same claim. We perform B-scan imaging of the complete abdomen and report 76700. Then we perform a renal vascular Doppler exam--duplex Doppler of all renal arteries and the aorta--for malignant hypertension. Should we be doing something differently to receive payment for both?


Louisiana Subscriber

Answer: First, make sure the radiologist really is performing and documenting the exams you're reporting.

If the radiologist performs the exams for suspected renovascular hypertension, he is probably doing a retroperitoneal ultrasound exam (76770-76775) rather than an abdominal ultrasound exam (76700-76705). Depending on their policies, payers may not cover an abdominal ultrasound for hypertension.

For duplex exam of the renal arteries, code 93976 (Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; limited study) may be more appropriate.

If you also evaluate the renal veins, you'd report a complete study (93975, ... complete study). The code you're now using (93978, Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; complete study) is more appropriate for evaluation of the aorta, for example, for suspected aortic aneurysm.

Remember: Be sure that you have an order for both the ultrasound and the duplex (for non-hospital exams) and that both exams are fully documented. Because these are two separate exams, the radiologist should dictate separate reports.

Alternative: If 93978 and 76700 accurately describe the services provided, your payer may be questioning the medical necessity of performing both exams. But the examinations are directed toward two complementary but different diagnostic targets and use complementary but different technologies, so both could be justified depending on the reason(s) for the tests.

The denials may stem from a review of your practice's routine coding and examination patterns or incomplete ICD-9 coding that doesn't support both studies. The studies need to be medically appropriate and documentation-supported.