Doppler arterial infl/ outflow

RADCODER

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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!
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RADCODER

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Yes, that is true. In a hospital setting the Radiologist can make that decision based on medical necessity. I am wondering if how everyone else handles this?
 

donnajrichmond

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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!
__________________
The rad can add if medically necessary, but another part is whether they are actually doing the services required by 93975 or 93976. As an auditor, I can tell you that 99% of the reports I see for scrotal and ovarian ultrasounds that have 93975 / 93976 added on only document color flow. If that's all they are doing, then 93975 /76 should not be coded. You must have documentation of both color and spectral doppler, with both arterial and venous flow documented for 93975. For 93976 you must still have both color and spectral doppler, but it can be just arterial or just venous, or just 1 of paired organs.
 

jmcpolin

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Donna, once upon a time I had some great documentation regarding that, do you know where I might find those guidelines?
 
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