93970

Hello,

I have a question regarding CPT 93970, if a provider is checking the lower extremity superficial venous system for evidence of reflux and also checking for deep venous thrombosis, would that be considered two different scans?? Would you code that as 93970, 93970-59 or would you only use CPT 93970 once. I have a provider that is billing that code twice and I think it should only be once. If there is any documentation stating the correct way to bill this service please include the website so I may look it up.

Thank-you very much!
JB*

re: 93970

Bumping this. CMS shows an MUE of 1 for 93970; I have a physician who insists they have to do the test twice--once for lower extremities reflux, once for lower extremities DVT. He sure there must be some way to make Medicare pay for both tests.

ACR(American College of Radiologists) has a list of ultrasound evaluation attributes; the only difference between testing for DVT and for venous incompetence is the addition of Spectral analysis of flow with color Doppler of the common femoral vein, Superficial femoral vein & popliteal vein (bilaterally).

Would it help if he documented both tests in the same report, taking care to document each portion separately? (e.g. bilat leg pain & edema, checked for thrombosis by doing xyz, here aree the results. Allowed patient to rest for 1/2 hour, then checked for venous incompetence by doing xyz+, here are the results. Here are the reasons we needed to do xyz twice instead of just adding + at the end.)

re: 93970

THIS IS WHAT MY CCI EDITS SOFTWARE STATES: 150% payment adjustment does not apply. RVUs are already based on the procedure being performed as a bilateral procedure. If the procedure is reported with modifier -50 or is reported twice on the same day by any other means (e.g., with RT and LT modifiers or with a 2 in the units field), base the payment for both sides on the lower of (a) the total actual charge by the physician for both sides, or (b) 100% of the fee schedule for a single code. Example: The fee schedule amount for code YYYYY is $125. The physician reports code YYYYY-LT with an actual charge of $100 and YYYYY-RT with an actual charge of $100. Payment should be based on the fee schedule amount ($125) since it is lower than the total actual charges for the left and right sides ($200). The RVUs are based on a bilateral procedure because (a) the code descriptor specifically states that the procedure is bilateral, (b) the code descriptor states that the procedure may be performed either unilaterally or bilaterally, or (c) the procedure is usually performed as a bilateral procedure.

This is a bilateral procedure already.. What modifiers have you tried?

re: 93970

Oh, I know it's bilateral (and why they don't have different codes for upper and lower extremities like they do for arterial is beyond me).

The problem is that the doctor says they have to do the complete bilateral procedure two times when they're looking for two different things. So he says they do it once when looking for thrombi, then do the entire thing again looking for venous insufficiency. I don't know why they can't look for both dvt and reflux at the same time, but he insists it's not possible.

The only way I think it might be (remotely) possible to get Medicare to pay for both is on appeal, but the documentation they provide would need quite a bit of beefing up for that to work. That's why I wondered if it would be helpful to document both tests in the same report.