Radiology Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer. Question: Can we report bilateral venous or arterial duplex scans as two unilateral procedures modified with the -RT and -LT modifiers if we use different diagnosis codes? Or should we bill them once and append modifier -50 (Bilateral procedure)? Maryland Subscriber

Answer: You should report the bilateral study code once without any modifiers appended. For example, if you perform a bilateral duplex scan of extremity veins, you should report one unit of CPT 93970 (Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study). Medicare carriers reimburse practices about $175 for one unit of 93970. Most payers reimburse about $125 for each unit of CPT 93971 (Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study). Therefore, some practices try inappropriately to increase their reimbursement by reporting 93971 with a bilateral modifier, hoping to exceed the $175 that they would recoup for 93970. You should never attempt to game the system this way. It is not legal and is certainly not considered correct coding.