Wiki 76830 and 76856 with doppler

[rehamebram@gmail.com]

I working with gynacologist he performed non obstetrics transabdominal and transvaginal ultrasound with doppler is it right to code these services like that?
76830
76856-59
93976-59-51
Thanks

 

[Cmama12]

Hi, so you are clinic based and not hospital? There is no edit of any kind on 76830 and 76856, so a modifier 59 is not applicable. Caution with 93976 - this is often dropped inappropriately. . Generally, they are doing a quick look for flow and this is not separately billable. See below

Duplex scanning of arterial inflow/venous outflow of abdominal, pelvic, or retroperitoneal organs may be coded with CPT code 93975, or with CPT code 93976, depending on whether a complete or limited study is performed.7 Report the duplex scan in addition to the CPT code for the abdominal, pelvic, or retroperitoneal real time ultrasound study, when both are ordered by the referring physician due to medical necessity, and both studies are performed and documented (check for CCI edits on these code combinations).
It is important to remember that the duplex study represented by codes 93975/93976 should not be coded when a quick look with color Doppler is done to check whether flow is present or for structure identification. Documentation of the assessment of flow with color, recording a spectral waveform, and a report of the findings should all be present to assign codes 93975/93976. It is the consensus of the ACR's Economics Committee on Coding and Nomenclature and the ACR's Economics Committee of the Commission on Ultrasound that these codes should only be used when medically necessary, appropriately documented, and when both spectral and color Doppler are performed.8

Pasted from <https://www.acr.org/Advocacy/Econom...-2007/Noninvasive-Vascular-Diagnostic-Studies

 

[csperoni]

As always, great advice by @Cmama12 !
I would add that while 76830 & 76856 are not NCCI edits, many carriers will bundle them.
For some carriers, if you bill with -59 you will receive payment for both. For some carriers, regardless of modifier, they will simply not pay for both sonograms.
So for coding guidelines, no modifier needed. For some payor guidelines, you may need it.
Additionally IF the doppler code is appropriate in your specific situation (it's probably not), link an appropriate payable diagnosis.

 

[DonnaSMirande321]

I have a situation where the GYN radiologist does CPT 93975 and 76830 with 76856, I do not understand how this works. I have been told that 76856 is global to 93975, if one is done the other should not be done. That 93975 is to check the if the flow is there if it is not the 76856 should be used. Am I being lead down the wrong path? Thank you for any help/advice/ guidance

 

[csperoni]

I have a situation where the GYN radiologist does CPT 93975 and 76830 with 76856, I do not understand how this works. I have been told that 76856 is global to 93975, if one is done the other should not be done. That 93975 is to check the if the flow is there if it is not the 76856 should be used. Am I being lead down the wrong path? Thank you for any help/advice/ guidance

Please reference the answer by @Cmama12 above from 03/24/2024 along with the reference link. If all that is being done via doppler is to check the flow, then 93975/93976 should not be coded.