Cardiology Coding Alert

Question: "Steer Clear of a Tempting $120 ABI Blunder" in Cardiology Coding Alert, Vol.12, No.4, recommended reporting two units of 93923 for multiplelevel bilateral studies of the arms and legs. My Medicare carrier told me 93923 has an MUE of "1." So how should I report both arm and leg studies?

Tennessee Subscriber

Answer: According to the CPT Assistant article cited (June 2001), the AMA supports reporting 93923 (Noninvasive physiologic studies of upper or lower extremity arteries, multiple levels or with provocative functional maneuvers, complete bilateral study [e.g.,segmental blood pressure measurements, segmental Doppler waveform analysis, segmental volume plethysmography, segmental transcutaneous oxygen tension measurements, measurements with postural provocative tests, measurements with reactive hyperemia]) twice when you perform "multiple level segmental Doppler waveform analysis of both the lower and upper limbs."

You should report the code twice according to your payer's preference.

CMS does list a Medically Unlikely Edit (MUE) for 93923 in the public file at www.cms.hhs.gov/NationalCorrectCodInitEd/.

In an MUE FAQ, CMS states, "Since each line of a claim is adjudicated separately against the MUE value for the code on that line, the appropriate use of Current Procedural Terminology (CPT) modifiers to report the same code on separate lines of a claim will enable a provider/supplier to report medically reasonable and necessary units of service in excess of an MUE value.

CPT modifiers such as -76 (repeat procedure by same physician), -77 (repeat procedure by another physician), anatomic modifiers (e.g., RT, LT, F1, F2), -91 (repeat clinical diagnostic laboratory test), and -59 (distinct procedural service) will accomplish this purpose. Modifier -59 should be utilized only if no other modifier describes the service."

In other words: If your documentation supports overriding the MUE, you should report two line items and append the appropriate modifier to the second code. Because you are reporting 93923 once for the upper limbs and once for the lower, modifier 59 is the most appropriate choice. You aren't repeating the same service (modifier 76) or reporting a service on the left and right (LT, RT).