Wiki Coding

[dpatel]

Can E&M code billed with Cpt code 93971 and 93970 on same day under same tax id # but different rendering provider. If answer is yes than the diagnosis code should be the same for E&M and venous ultrasound and do we need to append modifier?

 

[Pam Warren]

If they're billed under two different providers, even for the same practice, they're going to be on a separate claim form, however E&Ms don't bundle with diagnostic studies. However, 93971 is unilateral and 93970 is bilateral, so they're bundled unless they're separate structures, whereby you would use the -XS modifier on the 93971.

 

[csperoni]

Venous doppler sonos and E/M are not NCCI edits. No modifier should be required. Notice I use the word should as some carriers do not simply follow CMS guidelines and create their own. For example, E/M and a transvaginal sonogram should not bundle, but for at least one carrier, we must put -25 on the E/M.

If they were NCCI edits:
1) If the different providers are different specialties, no modifier would be required
2) If the different providers are the same specialty, you would use -25 (if appropriate per documentation).

Regarding the diagnoses, the code should be whatever the reason for the visit was on the E/M and whatever the reason for the sono was on the venous dopplers. They might be the same, might be different.