ABI bilateral code?

swallace1

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I work with a D.O. who is billing for ABI (ankle brachial indicies) in office, using 93922. The provider is billing 93922 times two for left and right. The code description reads bilateral. My assumption is that provider should only bill once? Any reference materials that I could present to provider would be appreciated.
 

cfuficat

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93922

Hi. CDR also says for bilateral single level 93922 and for multiple level bilateral 93923...same as the CPT book like you also stated....not sure what other reference material is out there but you are correct...ABI bilateral is only suppose to be coded once 93922 since it states bilateral=RT & LT????

Thanks,

Christy
RHIT, CPC
 

swallace1

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93922

Thanks for the reply. That was my thought. My concern is that this provider is billing both LT and RT and attaching the 59 modifier on the LT- in some cases she is getting paid. I think that the 59 modifier is overriding the claims adjudication system and while she is receiving payment, my concern is that this provider will come under audit for abuse of the 59 modifier.
93922 - states one level, for the ABI procedure measurements are taken at both the brachial and the ankle level on both sides. I think the provider thinks since two levels she can justify the use of 59. However, I think since the procedure inherently includes bilateral, both ankle and brachial it should be just the one code.
 
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93923 is multiple levels

NOT my area of expertise but ...

Should she be using 93923 instead? (multiple levels, complete bilateral study)

F Tessa Bartels, CPC, CPC-E/M
 
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Abi and tcom done same day

QUESTION: Is is proper to bill with a modifier 59 if one physician performs CPT 93922 and another physician bills CPT 93923 on the same day. Medicare denies as bundled or already paid to another provider. Suggestions please
 

TamaraM

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93922 bilateral code...

MY UNDERSTANDING IS THAT THE ONLY TIME YOU WOULD B ABLE TO BILL 93922 AND A 93922-59-LT IS IF BOTH LOWER AND UPPER EXT STUDIES WERE DONE. (WHICH I BELIEVE WAS NOT DONE DONE.) I AM AWARE THAT IF THE STUDY WAS DONE ON ONLE ONE SIDE YOU BILL WITH THE MODIFIER -52) MEASURED... OTHER THAN THAT IT IS A BILATERAL STUDY.... HERE IS AN ARTICLE THAT MIGHT HELP http://www.radiologytoday.net/archive/rt061509p8.shtml
 

Ahern

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I know this post is a little older but just incase someone looks for this information, The code 93922 is considered a bilateral code. If it becomes unilateral you would add modifier 52.
You would only use 93922 twice with the modifier 59 (on the second) if both lower and upper extremities are completed.
 
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