Wiki E/M services w/93970 & 93971

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allenwein12

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I need help or some guidance. We are a multi-specialty group (PCP, RADS, CARDIO etc.)

Our RAD is having our PCP docs select potential patients for the 93970. Once the patient is selected (eval & order written) the PCP then brings the RAD in one day a week so he can do the 93970 or 93971 on said patient(s). The PCP office is doing an E/M (99212) on the same day. The RAD bills for the global 93970/71 because he brings his equipment to the PCP office and the PCP bills for the E/M (99212). The 99212 is focused on the extremity the RAD is doing the 93970/71 on, it's not a separate problem.

Is this kosher? Prior to doing things this way the RAD was billing the 99212 and 93970/71 on the same day under his provider number.

I believe the 93970/71 includes a basic exam, does it not? My bosses say the LCD isn't clear, but I think it is clear. "Vascular studies include patient care required to perform the study, supervision of the study and interpretation of the study results....".
:confused:
THANKS to anyone who can help.
Laura WPB
 
93970 and 93970 have a global status code of XXX. Per the Medicare NCCI Coding Manual these codes do NOT have any E&M work included into the work of the code. This is a medicine code. Per the guidelines, these codes are exempt from the modifier 25 rules, but do require a modifier 25 appended to an E&M when reported on the same date of service.

So if the PCP is doing an E&M, what is the medical decision making documented to support a level 99212, simply gather an all ready known history and brief exam is not sufficient in my eyes to support medical necessity for the visit. If the studies are pre-scheduled I would hesitate to support reporting an E&M, unless there is a separate problem unrelated to the studies performed. Just my two cents only.
 
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