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Wiki help with Vascular coding
- Thread starter Monica820
- Start date
Pam Warren
True Blue
93925 for the bilateral duplex is the only correct code, and payers will deny if you get creative with CPT. Unless adding their sixth digit is some sort of internal identifier they are using (such as a chargemaster number), I would make sure their documentation supports the code and bill only the 93925 if appropriate. I'm guessing they're billing with the -26 modifier, unless the duplex is being done in their office.
The physician office has been billing these codes like this to the insurance company and they are not denying them. They are not adding any modifiers to these codes either. The previous billing company that they used told the MD office that they needed to add a 0 or a 1 on the end of any codes starting with 939. We have tried to narrow them down and see if it was for only 1 payer but it is not. Would insurance companies omit the 5th digit thinking they were put on in error?
Pam Warren
True Blue
I'd call the payer reps. I have never heard of such a thing, but I haven't worked in billing for a number of years, so maybe something is new that I am unaware of.