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Radiology Coding Alert

Reader Questions:

76856 Needs Modifier 59 With 93975

Published on Tue May 03, 2011

Question:May we bill 76856 together with 93975 using modifier 59?Codify MemberAnswer:Yes, you may report the two codes together when documentation supports that choice. Correct Coding Initiative edits bundle 76856 (Ultrasound, pelvic [nonobstetric], real time with image documentation; complete) into 93975 (Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; complete study). The edit's modifier indicator of 1 means that you may override the edit in appropriate cases. You should append modifier 59 (Distinct procedural service) to 76856 when documentation supports overriding the edit.Before you consider reporting both codes, verify that your documentation meets CPT®'s requirement that the provider must perform both color and spectral Doppler to report a Doppler exam. In the Diagnostic Ultrasound guidelines, CPT® also states you may not report color Doppler performed simply for anatomic structure identification with a real-time ultrasound.Best bet: The radiologist should dictate a separate paragraph for [...]
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