Normally a varicose vein patient’s care plan includes an US three days to one week after an ablative procedure was performed to determine if the treatment was successful and to look for any complications such as a DVT. This service has been billed with two commonly used codes interchangeably depending on the practice.
By far the most commonly used code is 93971, Duplex Scan of the Lower Extremity unilateral or limited. While this code seems to accurately encompass the service performed, it is best to keep in mind that this service is considered a Diagnostic study. Per the description it can be used for either a unilateral or bilateral service. If it is performed on the same day as an ablation it is considered inclusive.
It should indeed be inclusive if the ablation is performed on the same leg as the follow-up ultrasound, but what if it is on the opposite leg? Is it still included? The answer to this question unfortunately is yes, it is, because of the nature of the code.
A less common alternative is the CPT code 76970, Ultrasound Study Follow-up. This code was created to be used as a post-procedural US. This is exactly the reason that Phlebology providers are performing an ultrasound. Because it is not considered diagnostic in nature and is a lesser service taking less time to perform, it is therefore not included in the ablative procedure and can be billed the same day as an ablation. This would seem to be a more appropriate code to bill for the “rule out DVT” study that all phlebology providers perform.
A word of caution is that this still cannot be billed if the follow-up study and another ablation are performed on the same extremity. This would be what coders call a “drive by”, meaning that you are already imaging the leg for the ablation and looking at one more vein and billing separately for that ‘look’ is not allowed.
We recommend you review the descriptions of the codes in the ICD-10 books and the documentation requirements as outlined by the ACR.
Cheryl: While I will agree on the coding – reporting the F-up Scan code (76970) rather than the 93971 for Post-abltn (3+day) DVT R/O, but since I’ve never done it, not sure how the MACs will process the claim (Paid or denied?) – And as far as I can tell working with 6 MACs, the F-up code IS NOT referenced in any Carrier LCDs. Do you have clients billing the 76970 vs 93971 for Post-abltn scans? Are they being paid since CPT is outside LCD? A follow-up article is definitely due….
Has anyone heard of any payment for this code? we also have never billed it. What about follow up studies after 6 months?
No, we have not billed this code out and we are considering it but I cannot find any LCD documentation. I did find that the code is bring review to become obsolete.