Wiki 93970 - 93971 with office visit? ESRD pt

[msuprun13@gmail.com]

Can somebody help me please?
ESRD patient was scheduled for Duplex scan (90970), and Dr. decided to do office visit (99213) also. I will code it
99213 -25; 93970

and
Dx.: I87.1
N18.6

, but Dr.'s notes: HPI- states reason for visit is Duplex scan for stricture of the vein (nothing else)
ROS 8 elements + 1 history
and than examination and MDM of level 3 visit.
Can somebody tell me if this is billable ?

 

[Pathos]

So the description for Modifier 25 is:
"Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service"

From what you are sharing with us, I do not see the significant and separately identifiable E/M reason to also code an E/M visit. Keep in mind that all procedures have a small E/M already built in. Unless documentation clearly show another reason for the 99213, I would be cautious.

I would bill only the Duplex scan on this one (93970).

 

[devinmajor14]

And do not code N18.6 with 93970-93971 because it is not in the LCD.

 

[msuprun13@gmail.com]

Thank you so much for your help.