djreiff
Contributor
Good morning! I have several claims where 76705 and 93975 were billed together, and the 76705 denied as bundled with the -59 modifier added. I am trying to find information on when these can and cannot be billed together, or when 76705 is truly supported independently. Below is an example of the note. In your opinion, does the documentation support billing 76705 independently? Any help is greatly appreciated!
PROCEDURE: US LIVER DOPPLER
HISTORY: Liver transplant 2005. Assess portal venous flow.
TECHNIQUE: Grayscale ultrasound of the liver transplant was performed. Color flow and spectral Doppler evaluation was included to evaluate the vasculature for patency.
COMPARISON: Liver transplant ultrasound dated 1/25/2018.
GRAYSCALE MEASUREMENTS:
Liver transplant length: 12.8 cm
Common duct diameter: 0.4 cm
Spleen length: 12.2 cm
Right renal length: 7.7 cm
Left renal length: 7.7 cm
GRAYSCALE LIVER FINDINGS:
LIVER: The liver transplant is not enlarged. There is heterogeneity to the echogenicity in the liver with coarsening of the echotexture, which can be seen with fibrotic change. The surface of the liver is mildly lobulated along the anterior left hepatic lobe.
COLOR FLOW AND SPECTRAL DOPPLER IMAGING FINDINGS:
There is hepatopetal flow in the main portal vein. Slightly slow flow is seen in the left portal vein.
Arterial flow is seen in the hepatic arteries with sharp systolic upstrokes and diastolic flow present. Calculated resistive indices for the hepatic arteries are upper limits of normal.
Flow in the hepatic veins and inferior vena cava is phasic.
SPECTRAL DOPPLER MEASUREMENTS:
Peak velocity in the native main portal vein: 17 cm/sec; previously 19 cm/sec
Peak velocity in the region of the portal vein anastomosis: 27 cm/sec; previously 28 cm/sec
Peak velocity in the donor main portal vein: 17 cm/sec; previously 30 cm/sec
Peak velocity in the anterior branch of the right portal vein: 14 cm/sec; previously 15 cm/sec
Peak velocity in the posterior branch of the right portal vein: 18 cm/sec; previously 13 cm/sec
Peak velocity in the left portal vein: 8 cm/sec; previously 9 cm/sec
Peak systolic velocity in the hepatic artery in the liver hilum: 53 cm/sec; previously 55 cm/sec
Resistive Index in extrahepatic main hepatic artery: 0.78; previously 0.78
Resistive Index in hepatic artery at liver hilum: 0.81; previously 0.82
Resistive Index in intrahepatic main hepatic artery: 0.79; previously 0.72
Resistive index in anterior branch right hepatic artery: 0.76; previously 0.77
Resistive Index in posterior branch right hepatic artery: 0.77; previously 0.80
Resistive Index in lateral left hepatic artery: 0.75; previously 0.80
Resistive Index in the medial left hepatic artery: 0.72; previously 0.73
SPLEEN: The spleen is normal in size.
FLUID COLLECTIONS: There is no free fluid in the upper abdomen. There is no perihepatic collection.
PANCREAS:The pancreas is not seen.
KIDNEYS: The native kidneys are small in size. There is increased echogenicity to the renal parenchyma. There is no collecting system dilatation.
AORTA: The superior abdominal aorta is poorly seen.
OTHER: No pleural effusion is seen.
IMPRESSION:
Patent hepatic transplant vasculature. The left portal vein now demonstrates hepatopetal flow and is no longer to and fro, however the velocity remains slow at 8 cm/sec.
Calculated resistive indices in the hepatic arteries are mildly improved and remain upper limits of normal. The peak systolic velocity in the hepatic artery hilum is within normal limits.
The liver is heterogeneous in echogenicity with a slightly coarsened echotexture, which can be seen with fibrotic change. Other infiltrating processes are not excluded. These findings limit evaluation for intrahepatic masses. Consider further evaluation with ultrasound elastography to assess for fibrotic change. MRI could be obtained for further evaluation of the parenchyma.
Atrophic native kidneys with increased echogenicity. The patient has a history of a kidney transplant.
