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Radiology Coding Alert

You Be the Coder:

Dont Split Bilateral Services

Published on Sat Mar 01, 2003

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.

Question: Can we report bilateral venous or arterial duplex scans as two unilateral procedures modified with the -RT and -LT modifiers if we use different diagnosis codes? Or should we bill them once and append modifier -50 (Bilateral procedure)?

Maryland Subscriber



Answer: You should report the bilateral study code once without any modifiers appended. For example, if you perform a bilateral duplex scan of extremity veins, you should report one unit of CPT 93970 (Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study).

Medicare carriers reimburse practices about $175 for one unit of 93970. Most payers reimburse about $125 for each unit of CPT 93971 (Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study). Therefore, some practices try inappropriately to increase their reimbursement by reporting 93971 with a bilateral modifier, hoping to exceed the $175 that they would recoup for 93970. You should never attempt to game the system this way. It is not legal and is certainly not considered correct coding.

 



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