Radiology Coding Alert

Question: Can we bill code 76775 with code 93975? Can we append modifiers? Please advise.

Ohio Subscriber

Answer: You cannot report ultrasound, 76775 (Ultrasound, retroperitoneal [e.g., renal, aorta, nodes], real time with image documentation; limited) with duplex examination, 93975 (Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; complete study) of the same visceral area unless these are medically necessary and reasonably performed in the same clinical scenario.

If both examinations have their individual documentation reports containing descriptions of the elements visualized and recorded imaging reports to support their individual medical necessity, then you may bill these together with appropriate modifiers. You may report 93975-26 (Professional component) and 76775-59 (Distinct procedural service), 26.

At times, your radiologist may be performing the duplex scan in conjunction with real-time ultrasound only for identifying the anatomic structure. This scan does not involve production of a hard copy or real-time images in output record allowing analysis of bidirectional vascular flow. In this scenario, the duplex scan is not separately reportable with real-time ultrasound services, i.e., you report only 76775.