The question here is whether you can bill a bilateral scan (93970) along with an office visit and get paid for both. Also, would you need to use modifier 25 on the office visit?
Well, you may report an evaluation & management service and 93970 (Duplex scan of extremity veins together with responses to compression and other maneuvers; entire bilateral study) on the same claim. Whether you need to add modifier 25 (Significant, separately identifiable evaluation & management service by the same doctor on the same day of the procedure or other service) may depend on your payer.
Details: As per the Medicare physician fee schedule, the global period for 93970 is XXX. According to Medicare's Correct Coding Initiative (CCI) manual, chapter 1, section D, if you have a truly separate evaluation & management, you may report it on the same day as a XXX procedure. The manual further says that you should add modifier 25 to the evaluation & management code. (As we said above, different payers may have different requirements for use of modifier 25, more so since you won't find evaluation & management codes bundled with 93970 in the listed CCI edit pairs.)
Note of caution: The CCI manual sets out the following rules:
Well, you may report an evaluation & management service and 93970 (Duplex scan of extremity veins together with responses to compression and other maneuvers; entire bilateral study) on the same claim. Whether you need to add modifier 25 (Significant, separately identifiable evaluation & management service by the same doctor on the same day of the procedure or other service) may depend on your payer.
Details: As per the Medicare physician fee schedule, the global period for 93970 is XXX. According to Medicare's Correct Coding Initiative (CCI) manual, chapter 1, section D, if you have a truly separate evaluation & management, you may report it on the same day as a XXX procedure. The manual further says that you should add modifier 25 to the evaluation & management code. (As we said above, different payers may have different requirements for use of modifier 25, more so since you won't find evaluation & management codes bundled with 93970 in the listed CCI edit pairs.)
Note of caution: The CCI manual sets out the following rules:
You shouldn't report a separate evaluation & management code to represent physician supervisor or interpretation of another provider's performance of a XXX procedure that has no physician work relative value units (RVUs).
Bonus tip: If both bilateral upper and lower studies are carried out on the same date and/or session, report 93970 twice and modifier 59 (Distinct procedural service) to one of the codes.
Resource: Take a look at the CCI manual online at www.cms.gov/NationalCorrectCodInitEd/.
Bonus tip: If both bilateral upper and lower studies are carried out on the same date and/or session, report 93970 twice and modifier 59 (Distinct procedural service) to one of the codes.
Resource: Take a look at the CCI manual online at www.cms.gov/NationalCorrectCodInitEd/.
