06/01/2017

Plan Coverage Regarding CPT 93922 & 76882

Our office has three Blue Cross patients, one Magnacare patient and one United Healthcare patient on whom we performed a Doppler (CPT 93922) and a diagnostic ultrasound (CPT 76882) service on the same day for a diabetic patient. Only the Doppler was covered. When our billing manager called BC?BS she was told that due to CCI the two services cannot be reimbursed on the same day. Aetna and the Empire plan continue to reimburse for both services when performed on the same day as has United Healthcare with different patients. What is the state policy on this issue?

According to the Medicare LCD policy for non-invasive vascular testing, there are no specified limitations about billing an ABI with limited ultrasound. Reviewing the CCI edits for the two CPT codes listed, CPT 76882 is considered to be a component of CPT 93922 but may be reimbursed separately with modifier -59. If any insurance, such as Blue Cross, is denying the less comprehensive service as bundled and modifier -59 is appended to CPT 76882, documentation would need to be submitted to justify why it was necessary to perform both tests in order to receive additional payment.