LeahJ123
New
Hi everyone,
I am hoping someone can help interpret the NVDS rule in above link for me. I have providers billing on same DOS:
93925: Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study
and
93922: Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries, (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus bidirectional, Doppler waveform recording and analysis at 1-2 levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus volume plethysmography at 1-2 levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries with, transcutaneous oxygen tension measurement at 1-2 levels).
(bolded emphasis added
Per Medi-Cal, Billing Frequency Limitations For CPT codes 93880 through 93931, 93970 through 93981, 93985, 93986 and 93990, only one NVDS is reimbursable when billed by the same provider, for the same recipient and same date of service. Reimbursement for an NVDS is not to exceed the price on file for the complete test if both the complete and limited test procedure codes of the same service are billed by the same provider, for the same recipient and same date of service. When the code frequency for NVDS is exceeded, a Remittance Advice Details (RAD) will be issued directing the provider to resubmit the claim with documentation of medical justification. A current history and physical, or a current progress note that states the recipient’s diagnosis and need for additional NVDS should be included with the claim. If available, prior studies should be submitted to further support the need for medical necessity.
Complete/Limited NVDS Billing for both a single level/unilateral/limited non-invasive vascular diagnostic study and the corresponding multiple level/bilateral/ complete non-invasive study is considered duplicate billing. If the single level/unilateral/limited procedure has been previously reimbursed, the corresponding multiple level/bilateral/complete procedure will be reduced by the amount reimbursed in history. If the multiple level/bilateral/complete procedure has been previously reimbursed, the corresponding single level/unilateral/limited procedure will be denied.
‹‹Code Sets Table››
Limited/Complete
93882/93880 Duplex scan of extracranial arteries
93888/93886 Transcranial Doppler study of the intracranial arteries
93922/93923 Non-invasive physiologic studies of upper or lower extremity arteries
93926/93925 Duplex scan of lower extremity arteries or arterial bypass grafts
I am interpreting this to mean that only one NVDS per paired code set can be paid in one day as they clearly explain that if a limited study is performed on the same date as a complete study of the same service, only the complete study per DOS will be paid. Are there any vascular gurus out there than can help interpret this? Much appreciate everyones input!
I am hoping someone can help interpret the NVDS rule in above link for me. I have providers billing on same DOS:
93925: Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study
and
93922: Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries, (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus bidirectional, Doppler waveform recording and analysis at 1-2 levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus volume plethysmography at 1-2 levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries with, transcutaneous oxygen tension measurement at 1-2 levels).
(bolded emphasis added
Per Medi-Cal, Billing Frequency Limitations For CPT codes 93880 through 93931, 93970 through 93981, 93985, 93986 and 93990, only one NVDS is reimbursable when billed by the same provider, for the same recipient and same date of service. Reimbursement for an NVDS is not to exceed the price on file for the complete test if both the complete and limited test procedure codes of the same service are billed by the same provider, for the same recipient and same date of service. When the code frequency for NVDS is exceeded, a Remittance Advice Details (RAD) will be issued directing the provider to resubmit the claim with documentation of medical justification. A current history and physical, or a current progress note that states the recipient’s diagnosis and need for additional NVDS should be included with the claim. If available, prior studies should be submitted to further support the need for medical necessity.
Complete/Limited NVDS Billing for both a single level/unilateral/limited non-invasive vascular diagnostic study and the corresponding multiple level/bilateral/ complete non-invasive study is considered duplicate billing. If the single level/unilateral/limited procedure has been previously reimbursed, the corresponding multiple level/bilateral/complete procedure will be reduced by the amount reimbursed in history. If the multiple level/bilateral/complete procedure has been previously reimbursed, the corresponding single level/unilateral/limited procedure will be denied.
‹‹Code Sets Table››
Limited/Complete
93882/93880 Duplex scan of extracranial arteries
93888/93886 Transcranial Doppler study of the intracranial arteries
93922/93923 Non-invasive physiologic studies of upper or lower extremity arteries
93926/93925 Duplex scan of lower extremity arteries or arterial bypass grafts
I am interpreting this to mean that only one NVDS per paired code set can be paid in one day as they clearly explain that if a limited study is performed on the same date as a complete study of the same service, only the complete study per DOS will be paid. Are there any vascular gurus out there than can help interpret this? Much appreciate everyones input!