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Old 07-29-2010, 10:45 AM
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Default 93970 & 93971

This one is complicated!


I am curious to know how everyone codes 93970 & 93971. What guidelines do they follow? According to the CPT book..
93970: DUPLEX SCAN OF EXTREMITY VEINS INCLUDING RESPONSES TO COMPRESSION AND OTHER MANEUVERS; COMPLETE BILATERAL STUDY
93971: DUPLEX SCAN OF EXTREMITY VEINS INCLUDING RESPONSES TO COMPRESSION AND OTHER MANEUVERS; UNILATERAL OR LIMITED STUDY
So apparently I never noticed 93971 states unilateral OR limited. According to Medicare’s website.. https://www.highmarkmedicareservices...a47801-r5.html

Article Text
Coding Guidelines
The HCPCS/CPT code(s) may be subject to Correct Coding Initiative (CCI) edits. This information does not take precedence over CCI edits. Please refer to CCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare.
To report non-invasive peripheral venous studies for select medically necessary preoperative examinations use:
CPT code 93971 - duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study for the following:
• Preoperative examination of potential harvest vein grafts to be used during bypass surgery. This is a covered service only when the results of the study are necessary to locate suitable graft vessels. The need for bypass surgery must be determined prior to performance of the test. Only one preoperative scan is covered for bypass surgery. Use ICD-9-CM code V72.83 when reporting this procedure.
HCPCS code G0365 – vessel mapping of vessels for hemodialysis for the following:
• Preoperative examination of vessels prior to hemodialysis access site surgery in patients with end stage renal disease. This is a covered service only when the results of the study are necessary to determine appropriate vessel selection (i.e., when the patient’s clinical evaluation does not readily lead to the selection of a vein that is suitable for creating a dialysis fistula). The need for a hemodialysis access site must be determined prior to performance of the test. Only one preoperative scan is covered per hemodialysis access site surgery. Use ICD-9-CM code V72.83 when reporting this procedure, with an eligible secondary diagnosis.
As noted above, correct coding guidelines indicate that CPT code 93971 should be used to report either a limited bilateral or a complete unilateral study (only one service should be reported).
The CPT code 93970 is described as a “complete bilateral study”. The CPT code 93971 states: “unilateral or limited study”. Both codes can be used for bilateral studies; 93970 for complete, and 93971 for limited. If a complete or limited bilateral study is done on both the upper and the lower extremities, the corresponding code can be reported once for each study performed (i.e., once for the upper extremities and once for the lower extremities). Providers should append modifier 59, distinct procedural service, to the second code to indicate that two separate, distinct studies were performed. There should be a separate written report / interpretation for each study performed.

Am I interpreting this correctly when I say if all veins are not documented then the study should be coded as a limited (93971)?
Any and all thoughts are greatly appreciated!!!!

Jessica O'Donnell CPC
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Old 08-04-2010, 01:11 PM
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According to CSI
93971 should only be charged when one extremity is examined; when less than a full exam is performed (for example, a follow-up study); when ultrasound is performed without Doppler evaluation; or when the exam is performed for venous mapping.

93970 A complete bilateral study of the lower extremity veins includes examination of the common femoral, superficial femoral, proximal deep femoral, greater saphenous and popliteal veins. The calf veins may also be examined.

A complete bilateral study of the upper extremity veins include examination of the subclavian, jugular maxillary, brachail, basilic, and cephalic veins. The forearm veins may also be examined.
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Old 08-04-2010, 02:05 PM
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So what do you think when Medicare says, " Both codes can be used for bilateral studies; 93970 for complete, and 93971 for limited. If a complete or limited bilateral study is done on both the upper and the lower extremities, the corresponding code can be reported once for each study performed (i.e., once for the upper extremities and once for the lower extremities)" ??

And now you say,"According to CSI
93971 should only be charged when one extremity is examined; when less than a full exam is performed .."

Now what??
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Old 08-05-2010, 06:57 AM
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CSI also says if less than a full exam is performed than bill 93971 so I would bill it if the exam is bilateral and only a limited area is studied.

Hope this helps!
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Old 08-05-2010, 08:05 AM
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Also, this article from the ACR may help you...

http://www.acr.org/Hidden/Economics/...ticStuies.aspx

A few questions commonly occur when coding for noninvasive vascular scans of the extremities. If a limited bilateral study is performed, the code used should be the “unilateral or limited study” codes (93926, 93931, 93971). These codes are not just for a unilateral, or limited unilateral study, but encompass a bilateral study, which is otherwise limited, as opposed to complete. The physiologic study codes state “upper or lower extremity,” making it appropriate, when both upper and lower extremities are studied, to report the code twice.
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Old 08-05-2010, 01:53 PM
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c422rad- Yes that does help a lot! Thanks for your help!
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Old 04-23-2012, 09:26 AM
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Smile CPT Code 93971

I was told that 93971 required a report when using this code for venous scans to determine if treatment is necessary.
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