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Doppler arterial infl/ outflow

RADCODER

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Monmouth
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Everyone please feel free to respond... I apologize that I am not very technical

15year old female came into outpatient US Dept a day after visiting her Pediatrician. Her RX states, "Sonogram of the abdomen and pelvis. DX Abdominal pain/ hematuria."

US Tech asks the patient why she is there, patient tells her diffuse abdominal pain and hematuria. Based on patient complaint the tech adds on (93975/93976) Doppler Arterial inflow/outflow to rule out ovarian torsion.

I understand they should not be added routinely, however only when medically necessary. Does this vary from state to state? I am in NJ and we have a protocol for these types of exams and would like to make sure we are maintaining compliance. How does everyone else handle these in their outpatient hospital settings?

Thank you very much!
__________________
Jessica O'Donnell CPC
 

cblack712

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I would have two issues with this one...... first - the tech is not a practioner and should not be ordering exams or deciding what exams patients should and should not have. The only one that is legally able to order a medical test is a medical provider. Aside from all of the legal issues behind that you are running into an issue with patients insurance - exams may not have been preauthorized and you would not be able to provide an order for the inflow/outflow study and without an order can not bill

Second - if those procedure are done at the same time they must each be individually documented and show medical necessity for the additional exam - which you can't do because it was not thought medically necessary by the ordering provider - that is not a standard that varies from state to state. It is a nationally adopted policy. Some carriers have more specific rules regarding billing the two, however you won't find very many that are widely different.

I am sorry if that sounds a little snotty - but it really does creep me out when techs take matters into their own hands. :)
 

RADCODER

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Messages
146
Location
Monmouth
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I apologize. I should have told you that it is the hospital's protocol for the US Tech to add the arter inflow/outflow based on certain signs/symptoms per the Radiologist. The radiology department feels it is medically necessary to routinely add the additional procedure based on specific signs/symptoms to r/o torsion. I am questioning how does everyone else come to bill the duplex exam? Do they have a routine protocol in place?

Thanks,
 
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