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Wiki 76856 and 93975

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kathleenl

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Good Afternoon,
We are finding a lot of rejections from United Healthcare in particular on this coding combination. They state that 76856 is included in 93975 and this is confusing me a lot! Can anyone shed some light on this for me - particuraly why/how one is included in the other - the description of the doppler does not state anything about a sonogram....

ANY help / guidance is appreciated.

Thanks!
Kathleen
 
76856 & 93975 billing together

I think I would bill the 76856 (pelvic US) 1st and the 93975 with 59 modifier. I also would use different dx for the duplex.
The 76856 is the US and duplex scan is of venous and arterial doppler.
Hope it helps a little.
:o
 
According to coding guidelines, Evaluation of vascular structures using both color and spectral Doppler is separately reportable. To report, see Noninvasive Vascular Diagnostic Studies (93880-93990). However, color Doppler alone, when performed for anatomic structure identification in conjunction with a real-time ultrasound examination, is not reported separately.

If the ultrasound was completed in real time; CPT 93975 should not be reported separately. Hope this helps.
 
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