Wiki Valid medically necessary diagnosis codes for CPT code 93976

[Peggyam1]

Hi, I wanted to get some opinions on billing cpt code 93976 with diagnosis N83.291 for NY Medicaid. Is this a payable combo? According to CMS Article A56758, the diagnosis is not in the Group 5 Codes for cpt 93976. https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=56758&ver=54&=

 

[csperoni]

Most carriers will not consider N83.291 (or any ovarian cyst code) a payable diagnosis for 93976.
I will note that specifically in obgyn, during a pelvic or transvaginal sonogram, a quick Doppler reading will often be taken to measure flow, which is not 93976. Most obgyn situations, the 93976 is not separately billable and is included with the other sonogram(s). There was another thread regarding this with a great reference by @Cmama12 https://www.aapc.com/discuss/threads/76830-and-76856-with-doppler.197471/?view=date#post-544326

 

[Peggyam1]

Most carriers will not consider N83.291 (or any ovarian cyst code) a payable diagnosis for 93976.
I will note that specifically in obgyn, during a pelvic or transvaginal sonogram, a quick Doppler reading will often be taken to measure flow, which is not 93976. Most obgyn situations, the 93976 is not separately billable and is included with the other sonogram(s). There was another thread regarding this with a great reference by @Cmama12 https://www.aapc.com/discuss/threads/76830-and-76856-with-doppler.197471/?view=date#post-544326

Thank you Christine!