Health Information Management

Q&A: Why do we get denials on noninvasive vascular studies?

APCs Insider, May 30, 2014

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Q: We are receiving denial of our bilateral noninvasive vascular studies, like ankle/brachial indices. We sometimes perform a bilateral study of the upper and lower extremities and report two procedures. Our reimbursement manager just told us we are not getting paid for these and they want to stop doing them. Do you know what we can do to fix this?
 
A: The noninvasive physiologic studies are reported with CPT® codes 93922 and 93923 for the limited and complete studies, respectively. These codes represent bilateral procedures and the definitions to state “upper or lower” extremities.
The issue is not that you are reporting two procedures, but probably in how you are reporting them. If you are reporting one line item with two units on the claim, then that is what is causing the denial. There is a medically unlikely edit (MUE) for these codes that states one unit is the limit on the number of procedures that can be reported on a single claim line.
The correct way to report bilateral procedures of both upper and lower extremities is to report the code twice on separate line items, one with modifier -59 (distinct procedural service), according to the NCCI Manual. It is not correct reporting to just append modifier -59 to the line item with two units; it should not override the MUE, because the units on the line item are two. Chapter 11 of the NCCI Manual states:
 
CPT codes 93922 and 93923 describe bilateral noninvasive physiologic studies of the upper or lower extremities. The MUE value for each of these codes is one since it is unlikely that this testing would be performed on both upper and lower extremities on the same date of service. In unusual situation where testing on both the upper and lower extremities are performed on the same date of service, the appropriate code may be reported on two lines of a claim, each one unit of service and modifier -59 appended to the code on one of the claim lines.
 
Editor’s note: Denise Williams, RN, CPC-H, vice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Plantation, Fla., answered this question.



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