Wiki E/M services w/93970 & 93971

[allenwein12]

I need help or some guidance. We are a multi-specialty group (PCP, RADS, CARDIO etc.)

Our RAD is having our PCP docs select potential patients for the 93970. Once the patient is selected (eval & order written) the PCP then brings the RAD in one day a week so he can do the 93970 or 93971 on said patient(s). The PCP office is doing an E/M (99212) on the same day. The RAD bills for the global 93970/71 because he brings his equipment to the PCP office and the PCP bills for the E/M (99212). The 99212 is focused on the extremity the RAD is doing the 93970/71 on, it's not a separate problem.

Is this kosher? Prior to doing things this way the RAD was billing the 99212 and 93970/71 on the same day under his provider number.

I believe the 93970/71 includes a basic exam, does it not? My bosses say the LCD isn't clear, but I think it is clear. "Vascular studies include patient care required to perform the study, supervision of the study and interpretation of the study results....".

THANKS to anyone who can help.
Laura WPB

 

[OCD_coder]

93970 and 93970 have a global status code of XXX. Per the Medicare NCCI Coding Manual these codes do NOT have any E&M work included into the work of the code. This is a medicine code. Per the guidelines, these codes are exempt from the modifier 25 rules, but do require a modifier 25 appended to an E&M when reported on the same date of service.

So if the PCP is doing an E&M, what is the medical decision making documented to support a level 99212, simply gather an all ready known history and brief exam is not sufficient in my eyes to support medical necessity for the visit. If the studies are pre-scheduled I would hesitate to support reporting an E&M, unless there is a separate problem unrelated to the studies performed. Just my two cents only.

 

[allenwein12]

Thanks for your help. Good to know I was on the right track, just the wrong way so to speak. LOL