Radiology Coding Alert

Question: I was told I should use one of the X{EPSU} modifiers when pairing codes 76856, 76830, and 93976 together. Which modifier should I use?

Washington Subscriber

Answer: Before deciding upon what modifier to use, you need to know what code to append it to. This means you’ve got to check the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) edits between each of these three codes. From experience, you may know that you don’t need to append any overriding modifier when pairing 76856 (Ultrasound, pelvic (nonobstetric), real time with image documentation; complete) with 76830 (Ultrasound, transvaginal). No existing NCCI edit between these codes confirms this. You’ll also find that no NCCI edit exists between 93976 (Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; limited study) and 76830, either.

This means that the pairing of 76856 and 93976 is the culprit. NCCI indicates that you should append an overriding modifier, when appropriate, to the column two code 93976. In some instances, it would be impossible to advise on whether an NCCI-overriding modifier is allowable without having a look at the dictation report. However, in this case, you know merely by examining the code pairing that an overriding modifier is allowed. That’s because these two services, while overlapping the pelvic area, are not visualizing the same anatomic areas. While 76856 is visualizing the organ structure within the pelvic region, 93976 is exclusively reserved for imaging of the vascular structures within the pelvis and neighboring anatomic sites.

Furthermore, you shouldn’t be concerned with whether 93976 also includes imaging of the pelvis in addition to 76856. Rather, the overlapping sites don’t matter from a code-reporting perspective since different components of the same area are being visualized, respectively. With this in mind, you can now decide upon the most appropriate X{EPSU} modifier to append to 93976. In this case, there are actually two modifiers that work equally well. First, there’s XS (Separate structure, a service that is distinct because it was performed on a separate organ/structure). Since these codes are differentiated by organ system and vascular system, this modifier works to explain the reason for unbundling 93976 from 76856.

Additionally, you may append modifier XU (Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service). This modifier is also correct in that it explains that the two bundled services do not overlap, despite the code descriptions indicating mutual anatomic sites.