Wiki Duplex Scan

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tarafarmer

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I have an office that is performing Arterial scans. This is an area I an not tremendously familiar with, and could use some assistance. They have been billing 93925 (Duplex Scan) with 93922 (Limited bilateral non-invasive physiologic study). NCCI bundles these codes as being mutually exclusive. However, I have a radiology article that states it is appropriate to bill for both at the same visit.

Can someone help me understand what the difference is between these two test, so that I can understand a little better how to fight this denial I have?
 
Duplex ultrasound URL of this page: http://www.nlm.nih.gov/medlineplus/ency/article/003433.htm
.A duplex ultrasound is a test to see how blood moves through your arteries and veins.

The test combines traditional ultrasound with Doppler ultrasonography. Regular ultrasound uses sound waves that bounce off blood vessels to create pictures. Doppler ultrasound records sound waves reflecting off moving objects, such as blood, to measure their speed and other aspects of how they flow.

There are different types of duplex ultrasound exams. Some include:

•Arterial and venous duplex ultrasound of the abdomen examines blood vessels and blood flow in the abdominal area.
•Carotid duplex ultrasound looks at the carotid artery in the neck.
•Duplex ultrasound of the extremities looks at the arms or legs.
•Renal duplex ultrasound examines the kidneys and their blood vessels.

*****this is what i got for a Doppler study

.This test uses ultrasound to examine the blood flow in the major arteries and veins in the arms and legs.

How the Test is PerformedThe test is done in the ultrasound or radiology department or in a peripheral vascular lab.

To examine the veins:

A water-soluble gel is placed on a handheld device called a transducer, which directs the high-frequency sound waves to the artery or veins being tested.

To examine the arteries:

Blood pressure cuffs may be put around different parts of the body, including the thigh, calf, ankle, and different points along the arm. A paste is applied to the skin over the arteries being examined. Images are created as the transducer is moved over each area.
 
I understand the difference between the two now, so why is Medicare not paying for the 93923 when billed with the 93925? The physician's office is telling me that these are payable together, but Medicare is denying....has there been a change in NCCI edits from 2010 to 2011? Is there a modifier that we need to use? Please Help!!!!
Thanks
 
jbreen said:
I understand the difference between the two now, so why is Medicare not paying for the 93923 when billed with the 93925? The physician's office is telling me that these are payable together, but Medicare is denying....has there been a change in NCCI edits from 2010 to 2011? Is there a modifier that we need to use? Please Help!!!!
Thanks
Click to expand...

There are no CCI edits that prevent the two codes being billing together. Would need to know exactly what denial codes Medicare is using. Could it be a diagnosis code issue or some other missing information?
 
It is denying for "not deemed Medical Necessity" and an lcd audit, but when I look up the dx codes attached they are listed on the LCD Medicare website as medically necessary... 443.9 Unspecified Peripheral Vascular Disease. We are located in FL.. does that matter?

Thanks for your help.
 
jbreen said:
It is denying for "not deemed Medical Necessity" and an lcd audit, but when I look up the dx codes attached they are listed on the LCD Medicare website as medically necessary... 443.9 Unspecified Peripheral Vascular Disease. We are located in FL.. does that matter?

Thanks for your help.
Click to expand...

Well as far as the information in Encoder Pro goes, they should be allowed and the dx code supports medical necessity. Time for a phone call to the claims processor for Medicare in your region. Find out what exactly is not medically necessary since the claim seems to fit the rules. I checked the LCD for Florida and the dx code you are using is allowed with both scans.
 
Duplex scans are imaging studies and must include both color doppler and spectral analysis. Physiologic studies are non-imaging and use different equipment than the duplex scans. 93922 and 93923 require ABI plus another physiologic study. If only an ABI was done or documented, then 93922 or 93923 should not have been coded.

The diagnosis you have is a covered diagnosis for both, but the coding guidelines article accompanying both LCDs (FCSO) have this statement:

Duplex scanning (93925, 93926, 93930, and 93931) and physiologic studies (93922, 93923, and 93924) are reimbursed during the same encounter if the physiologic studies are abnormal and/or to evaluate vascular trauma, thromboembolic events or aneurysmal disease. Medical record documentation must demonstrate the medical necessity of performing both duplex scanning and physiologic studies on the same date of service.

Did FCSO request copies of the reports? If there weren't 2 separate reports, and if the medical necessity for both wasn't documented, they would deny.
 
I'm in NY and am looking for the same info, but I don't see it in the LCD. Is this something that changed, is it FL specific, or am I just not seeing it?

Bottom line question - can you bill 93922 and 93925 on the same day? Or do you need an abnormal 93922 to medically justify the 93925?
 
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