herrera4
Guru
Im getting denials on ultrasound procedures when more than one procedure(different) procedures are done-what is the correct way to bill these? thanks
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Wiki multiple u/s procedures
- Thread starter herrera4
- Start date
jgf-CPC
Guest
Please be more specific with which procedures are being done and thanks!
herrera4
Guru
the most recent denial was for 93880/93924 but i work for a vascular surgeon and i know there have been others. TIA
donnajrichmond
Guest
What denial/s are you getting?
Do you have medical necessity for both exams? It would be unlikely to need both a carotid duplex and a lower extremity doppler with exercise at the same session.
Do you have medical necessity for both exams? It would be unlikely to need both a carotid duplex and a lower extremity doppler with exercise at the same session.
herrera4
Guru
there is med nec. pt - pt has a history with us and was coming in for carotids but complained of leg pain dr wanted another u/s performed because of pt's history
donnajrichmond
Guest
To get a good answer you still need to provide us with the denial reason/s and whether one or both was denied.
Leg pain (by itself) is not considered a medically necessary reason to perform a vascular ultrasound. And carotid duplex scans have frequency limitations.
Check your LCD - as an example,
"Peripheral artery studies may not be considered medically necessary if only the following signs and symptoms are present:
• Continuous burning of the feet (considered to be a neurologic symptom);
• Leg pain, nonspecific (729.5) and pain in limb (729.5) as single diagnoses are too general to warrant further investigation unless they can be related to other signs and symptoms;
• Edema rarely occurs with arterial occlusive disease unless it is in the immediate postoperative period, in association with another inflammatory process or in association with rest pain; and/or
• Absence of pulses in minor arteries, e.g., dorsalis pedis or posterior tibial, in the absence of symptoms. The absence of pulses is not an indication to proceed beyond the physical examination unless it is related to other signs and/or symptoms.
And "Guidelines for follow-up cerebrovascular arterial studies include:
•Stenosis of 20-49% (diameter reduction), an annual study;
•Stenosis of 50-79%, every six months;
•Stenosis of 80-99%, every 6 months if surgery not performed; and/or
•After carotid endarterectomy, repeat ipsilateral/unilateral examinations are allowable at six weeks, six months, and one year. During the first year, follow-up studies should be on the ipsilateral side unless signs and symptoms or previously identified disease in the contralateral carotid artery provide indications for a bilateral procedure.
Leg pain (by itself) is not considered a medically necessary reason to perform a vascular ultrasound. And carotid duplex scans have frequency limitations.
Check your LCD - as an example,
"Peripheral artery studies may not be considered medically necessary if only the following signs and symptoms are present:
• Continuous burning of the feet (considered to be a neurologic symptom);
• Leg pain, nonspecific (729.5) and pain in limb (729.5) as single diagnoses are too general to warrant further investigation unless they can be related to other signs and symptoms;
• Edema rarely occurs with arterial occlusive disease unless it is in the immediate postoperative period, in association with another inflammatory process or in association with rest pain; and/or
• Absence of pulses in minor arteries, e.g., dorsalis pedis or posterior tibial, in the absence of symptoms. The absence of pulses is not an indication to proceed beyond the physical examination unless it is related to other signs and/or symptoms.
And "Guidelines for follow-up cerebrovascular arterial studies include:
•Stenosis of 20-49% (diameter reduction), an annual study;
•Stenosis of 50-79%, every six months;
•Stenosis of 80-99%, every 6 months if surgery not performed; and/or
•After carotid endarterectomy, repeat ipsilateral/unilateral examinations are allowable at six weeks, six months, and one year. During the first year, follow-up studies should be on the ipsilateral side unless signs and symptoms or previously identified disease in the contralateral carotid artery provide indications for a bilateral procedure.
herrera4
Guru
thanks for info- it was the 93924denied but the pt does have history of PVD. so if these 2 get billed together are any modifiers needed-was denied for CPT inconsist w/modifier or mod is miss
donnajrichmond
Guest
a modifier shouldn't be needed on 93924 with 93880. If you billing for the global procedure you shouldn't need a modifier for that - you'd only need a modifier if you are only billing for the technical or the professional component. Of course, if this is a private payer, they may have other modifier requirements.
Perhaps what they are looking for is modifier 59 to indicate it was a separate service.