deanaTuorto1!
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Can someone please explain to me the difference between a Limited 93971 and a Complete 93970 duplex scan?
I can find literature that states a complete scan is: To be complete you must image all deep and superficial veins in both legs to qualify for this code. Not only do you need to image and report on each of these veins, but you also need to have a good reason to perform a study at this level of detail. If a limited bilateral study is performed, the code used should be the “unilateral or limited study” codes (93926, 93931, 93971). These codes are not just for a unilateral, or limited unilateral study, but encompass a bilateral study, which is otherwise limited, as opposed to complete.
“For a complete examination, all deep veins of the leg are examined, including the common femoral, femoral, deep femoral, popliteal, peroneal, soleal, gastrocnemial, anterior, and posterior tibial veins. The superficial veins are then evaluated including the GSV, the SSV, the accessory saphenous veins, perforating veins, and tributary veins. Six components that should be included in a complete duplex scanning examination for CVD are (1) visibility, (2) compressibility, (3) venous flow, including measurement of the duration of reflux, (4) augmentation, (5) phasicity, and (6) vein size. The cutoff value of 500 ms is for the saphenous, tibial, deep femoral, and perforating vein incompetence, and 1 second for femoral and popliteal vein incompetence.”
If even one element is left out, or not addressed in the interpretation, then the study is not complete and has to be reported with 93971.
Currently we are billing as such: Patient presents and we perform 93970 bilateral complete study. After procedure 36475 we bill 93971 RT; 93971 LT or 93971 (depending on what procedures on which leg/legs were performed). I am under the impression that after a procedure a limited study whether unilateral or bilateral is medically necessary. We recently have a new coder who states that we should be billing 93970 not 93971. That 93971 limited means that it is restricted/confined to one area like the calf or thigh only and unilateral. That if the entire lower extremity was reviewed (calf and thigh) or several veins in each leg that we would code 93970. Basically we are interpreting complete/limited differently and I need to understand what limited really means.
Also, I have read that Medicare considers it not medically reasonable to code 93970 more than once in a 12 month period. Frequency denial- Is this correct? If a patient comes back after a 6 month period and we do a complete bilateral ultrasound is that medically reasonable or should we still only be billing a 93971? We are under Jurisdiction J-E Noridian Hawaii. "One item that seems to be missed is when a complete vs a limited study is warranted. Payers have been denying payment for complete studies when they have reached a frequency that they feel is more than would be necessary in any given timeframe, typically a 12 month period." The rationale behind this is that you, the provider, have already performed a complete study and made an assessment of the patient’s condition based upon this study. While care is being performed it would not be indicated to re-diagnose the patient, and instead only studies ordered to monitor the patient’s progress would be necessary. I cannot find any documentation on the Noridian Medicare website to support this information
Thank you
I can find literature that states a complete scan is: To be complete you must image all deep and superficial veins in both legs to qualify for this code. Not only do you need to image and report on each of these veins, but you also need to have a good reason to perform a study at this level of detail. If a limited bilateral study is performed, the code used should be the “unilateral or limited study” codes (93926, 93931, 93971). These codes are not just for a unilateral, or limited unilateral study, but encompass a bilateral study, which is otherwise limited, as opposed to complete.
“For a complete examination, all deep veins of the leg are examined, including the common femoral, femoral, deep femoral, popliteal, peroneal, soleal, gastrocnemial, anterior, and posterior tibial veins. The superficial veins are then evaluated including the GSV, the SSV, the accessory saphenous veins, perforating veins, and tributary veins. Six components that should be included in a complete duplex scanning examination for CVD are (1) visibility, (2) compressibility, (3) venous flow, including measurement of the duration of reflux, (4) augmentation, (5) phasicity, and (6) vein size. The cutoff value of 500 ms is for the saphenous, tibial, deep femoral, and perforating vein incompetence, and 1 second for femoral and popliteal vein incompetence.”
If even one element is left out, or not addressed in the interpretation, then the study is not complete and has to be reported with 93971.
Currently we are billing as such: Patient presents and we perform 93970 bilateral complete study. After procedure 36475 we bill 93971 RT; 93971 LT or 93971 (depending on what procedures on which leg/legs were performed). I am under the impression that after a procedure a limited study whether unilateral or bilateral is medically necessary. We recently have a new coder who states that we should be billing 93970 not 93971. That 93971 limited means that it is restricted/confined to one area like the calf or thigh only and unilateral. That if the entire lower extremity was reviewed (calf and thigh) or several veins in each leg that we would code 93970. Basically we are interpreting complete/limited differently and I need to understand what limited really means.
Also, I have read that Medicare considers it not medically reasonable to code 93970 more than once in a 12 month period. Frequency denial- Is this correct? If a patient comes back after a 6 month period and we do a complete bilateral ultrasound is that medically reasonable or should we still only be billing a 93971? We are under Jurisdiction J-E Noridian Hawaii. "One item that seems to be missed is when a complete vs a limited study is warranted. Payers have been denying payment for complete studies when they have reached a frequency that they feel is more than would be necessary in any given timeframe, typically a 12 month period." The rationale behind this is that you, the provider, have already performed a complete study and made an assessment of the patient’s condition based upon this study. While care is being performed it would not be indicated to re-diagnose the patient, and instead only studies ordered to monitor the patient’s progress would be necessary. I cannot find any documentation on the Noridian Medicare website to support this information
Thank you