Is a non-invasive arterial study considered diagnostic for NCCI purposes?

eutsler

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Per the hospital face sheet, the patient was scheduled for "abdominal aortogram, possible PTA stent" for right lower extremity claudication. My physician was the admitting physician. The doctor wants to bill for both the stenting and the angiography.

Indications for procedure state that the patient had already had an ultrasound which showed possible right SFA occlusion, and that the patient "now presents for diagnostic angiography and possible intervention."

My interpretation of this is that the doctor was already planning angioplasty and/or stenting, and that the angiography would qualify as a scout procedure under NCCI. Would the earlier 93926 be considered diagnostic, or would the intra-procedural angiography be warranted as a more detailed diagnostic tool?

I know what I think, but I'd really appreciate other opinions.

Thanks.
 

jamesalongi

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The non-invasive duplex would be a diagnostic study as long as it was performed in a seperate session with diagnostic intent.

The vascular angiography would also be billable as long as the physician's dictation supports it. From what I understand ultrasound has it's drawbacks. CT, MR, and angiography are considered much more accurate when assessing vascular issues. I've never actually had an outside auditor cite ultrasound when looking for prior diagnostic exams.

The indication stated "now presents for diagnostic angiography and possible intervention."... the key point in that statement is possible intervention which tells me there is a chance the intervention will not be performed if the duplex was not accurate. Most auditors will tell you documentation is key. I've had physicians give me what amounts to guiding shots or confirmatory imaging prior to intervention and those I would not bill. Other physicians will dictate whole paragraphs with statments of diagnostic intent, stenosis percentages, and medical necessity for intervention and those I would bill.
 
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