Radiology Coding Alert

Complete documentation alone can help build clean claims.

If you report non-invasive vascular studies, it’s time to take a closer look at your coding. A National Government Services (NGS) prepayment review resulted in that Medicare payer reducing or denying more than 80 percent of claims in January, February, and March.

Earlier this year, Medicare has been denying or reducing claims for duplex scans. According to a National Government Services (NGS) prepayment review, these denials could be as high as 80% of all claims. This alerts you to re-assess your coding for non-invasive vascular studies.

Check These Codes and Keep a Watch

NGS is conducting a service-specific prepayment review for JK Part B claims billed with the following duplex scan codes (checking in particular for multiple same-day codes, which should be rare):

Extracranial artery procedure codes:

• 93880 (Duplex scan of extracranial arteries; complete bilateral study), and
• 93882 (Duplex scan of extracranial arteries; unilateral or limited study)

Lower extremity artery procedure codes:

• 93925 (Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study), and
• 93926 (Duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or limited study)

Extremity vein procedure codes:

• 93970 (Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study), and
• 93971 (Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study).

Here are 5 key questions that you should ask yourself when reporting the duplex scan vascular procedures.

Question 1: What are the key documentation requirements for clean claims?

Answer 1: Documentation is key to clean and easy claims. To help ensure your claims meet Local Coverage Determination (LCD) and medical necessity requirements, review your MAC’s LCD. Your coding software may provide access, or you can find LCDs online by searching the Medicare Coverage Database at www.cms.gov/medicare-coverage-database/overview-and-quick-search.aspx.

Example: NGS LCD L33627 provides information on indications (like signs of vascular disease and an expectation that the outcome will affect patient management), limitations (such as, multiple same-day studies should be rare with medical necessity carefully documented), and ICD-10 codes that support medical necessity. The policy even offers help pertaining to which code you should use for certain cases, such as R09.89 (Other specified symptoms and signs involving the circulatory and respiratory systems) for carotid bruit.

Tip: Many practices are performing these scans before and after endovascular ablation therapy (EVAT) to justify those highly reimbursed services, says Terry A. Fletcher BS, CPC, CCC, CEMC, CCS-P, CCS, CMSCS, CMC, ACS-CA, SCP-CA, a healthcare coding educator, auditor, and management consultant.

She has seen for herself the issues that practices have with documenting the correct information to support medical necessity in line with LCD requirements.

“I’ve seen many reports that are routine computer-generated reports with no physician detail on indications and findings. When the findings (results) are normal, and there are no indications listed in the same report, these will be denied. The auditor should not have to go back to the original E/M service to find the order and indication. It should be clearly listed in the vascular study report,” Fletchers says.

Also: Make sure all required information for the beneficiary is properly completed in the documentation and in the claim. If the claim is correctly filled out, the problem may be with the documentation. If so, be sure to put beneficiary information on the agenda for the next documentation training session.

Question 2: How does laterality impact the codes for non-invasive vascular procedures?

Answer 2: If you don’t read to the end of each code’s descriptor, you may find yourself getting a denial.

The codes that the review focuses on essentially come in pairs: two codes for extracranial arteries, two codes for lower extremity arteries, and two codes for extremity veins. The distinguishing feature within each pair is whether the service is bilateral (complete) or unilateral (or limited):

Complete bilateral study: 93880, 93925, 93970

Unilateral or limited study: 93882, 93926, 93971

Remember: If the provider documents a bilateral service, but the services do not meet the requirements for a complete study, you should report the limited study code rather than the complete bilateral study code.

Question 3: How can one avoid duplicates in claims?

Answer 3: If you double up on your claims, you may see a denial. A second claim for a single service qualifies for denial. You should not submit duplicate claims to Medicare. If you haven’t been paid for a first claim, then check the status with the MAC. And if you discover an error on your initial claim, follow the MAC’s instructions on how to correct the error rather than submitting a second claim for the same service.

Another possibility is that your provider performs two distinct services, so you report the same code twice. “The X modifiers should help with this issue,” Fletcher suggests. For medically necessary vascular studies at separate same-day encounters, append modifier XE (Separate encounter).

Question 4: What are the key provider requirements for a clean claim?

Answer 4: In order to ensure your claim does not end up in the unpaid pile, you’ll need to double check your own work. Include in your pre-submission checklist confirmation that the claim’s rendering provider matches the provider in the documentation.

If you’re seeing denials due to problems with signatures, you’ll need to be sure that your providers understand Medicare’s signature requirements. 

Tip: Medicare provides many resources on the topic, such as MLN Matters SE1419 (www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE1419.pdf).

Question 5: What should one do if CMS sends a request?

Answer 5: Make sure you answer a request when CMS sends one.

When your MAC is performing a prepayment review or audit and requests documentation to support your claim, be sure you understand which code the payer needs to seek support for, get the right documentation in, and submit the information on time.