Wiki Duplex scan of extremities 93970&71

[JDM1228]

This isn't actually interventional radiology, but figured it was ok to put this question here
If a patient comes to our facility and has a venous ultrasound done on both the left upper extremity and the left lower extremity should we still only use the 93971 code for unilateral? CPT code 93970 states bilateral, but this isn't bilateral but two extremities were done. We are getting an edit saying we cannot modify 93971 with -59. I guess technically doing both extremities on the left side is unilateral.
Just wanted to get some thoughts on this.
Thanks!

 

[krishna.k]

Hi,

The CPT code 93970 is described as a “complete bilateral study”. The CPT code 93971 states: “unilateral or limited study”. Both codes can be used for bilateral studies; 93970 for complete, and 93971 for limited. If a complete or limited bilateral study is done on both the upper and the lower extremities, the corresponding code can be reported once for each study performed (i.e., once for the upper extremities and once for the lower extremities). we should append modifier 59, distinct procedural service, to the second code to indicate that two separate, distinct studies were performed. There should be a separate written report / interpretation for each study performed.Hope this helps.

Thanks,
Krishna.CPC

 

[tignordianeh]

Medicare is denying 93970 when billed twice, once for bilateral upper extremity study and once for bilateral lower extremity. I have appealed with copies of the medical reports and the appeal is denied. Medicare states that 93970 x 1 covers BOTH upper and lower extremities. I can see where they get this, the description reads: Complete bilateral study. That could be read as right and left SIDES, not upper and lower.

 

[jgf-CPC]

According to Clinical Examples in Radiology (Winter 2008), it is appropriate to report two units of code 93971 when the study includes one upper extremity and one lower extremity. They should be reported as 93971 and 93971-59. Hope this helps