Hi, please see the Question/Answer info and link below from SuperCoder regarding medical necessity and documentation:
http://www.supercoder.com/my-ask-an-expert/topic/can-you-code-76870-with-93976
User id : 19756Posted 2 years ago #
"The two codes are not bundled but I am wondering if it is correct to do a duplex study with every US scrotum study. I remember reading somewhere that you should have a justifiable reason to do the duplex study and that it shouldn't be "protocol" to do both on every study. Is there any documentation to back this up?
SuperCoderPosted 2 years ago #
CPT 76870, a diagnostic ultrasound,is ordered when the medical necessity is to report internal anatomy of scrotum and scrotal contents. The medical necessity like encysted hydrocele, azoospermia, oligospermia, orchitis and epididymitis reflect the need to order 76870.
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CPT 93976(duplex) is to monitor arterial blood inflow and venous outflow, so the medical necessity is entirely different focusing on vascular abnormality like aneurysm, thrombosis, vascular insufficiency, injury of blood vessels going towards and away from scrotal regions.
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Preconditions to perform both:
-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).
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-Duplex study represented by codes 93975/93976 should not be coded just for a quick look with color Doppler is done to check whether flow is present or for structure identification.
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-Documentation of the assessment of flow with color, recording a spectral waveform, and a report of the findings are MUST to assign codes 93975/93976."
I hope this information is helpful.
Jean Kayser CPC CIRCC
