Cpt Code 93882 Descriptive Essay

Cpt Code 93880 & 93882 for carotid Doppler Inroduction

In radiology, Cpt code for Carotid doppler is very frequently coded. The codes for carotid Doppler are very few. Only two CPT codes are used for carotid Doppler. Cpt code for Carotid doppler has very simple non-invasive arterial ultrasound procedure. Now, there are two CPT Codes used for carotid Doppler. The exam is performed to find any diagnosis or disorder present in carotid artery. Carotid arteries are present in the neck region. Cpt Code 93880 & 93882 for carotid Doppler is easy to code if we know the procedure. Now, let us check out the codes used for carotid Doppler.

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Cpt Code 93880 & 93882 for carotid ultrasound Doppler in detail

The codes used for carotid Doppler are 93880 and 93882. Both codes are used for coding in radiology facility. The only difference between the two codes is the Bilateral (93880) and Unilateral (93882) examination of carotid arteries. So, the code description for both codes is as below

93880 – Carotid Doppler Ultrasound Bilateral
93882 – Carotid Doppler Ultrasound Unilateral

The very commonly used CPT code for carotid Doppler is 93880 when the exam is performed on both carotid arteries. The exam is performed to find any occlusion or stenosis present in the carotid arteries of neck.

Procedure cost for CPT code 93880 and 93882

Professional component (93880-26)-$40.91

Technical component (93880-TC)- $164

In Hospital setting  – $205.64

Professional component (93882-26)-$25

Technical component (93882-TC)- $105

In Hospital setting – $131

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Diagnosis related to CPT code 93880 &  93882 for Carotid Doppler

The signs and symptoms related to carotid Doppler are like dizziness, syncope, numbness etc. However, the final diagnosis to find through this exam is stenosis. So, the main purpose to perform to carotid Doppler is to find stenosis or obstruction present in carotid arteries. The stenosis is measured and documented in percentage (%) to know to exact occlusion present in the carotid arteries. So, let us check out common diagnosis related to CPT code for carotid Doppler

Stroke
Cerebral Infarction
Occlusion of Carotid artery
Stenosis of Carotid Artery with/without Cerebral Infarction

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PQRS related to CPT code 93880 & 93882 for Carotid Doppler

The PQRS coded with CPT code for Carotid Doppler is Category II CPT Code 3100F. This PQRS comes under Measure 195. There are certain things to check to code 3100F with 8P or without 8P, let checkout them.
CPT II 3100F: Carotid Doppler ultrasound study report should document direct or indirect reference to measurements of distal internal carotid diameter as the denominator for stenosis measurement.
If the measurements of Distal Internal Carotid Diameter not Referenced or any other Reason not specified should append a reporting modifier 8P to CPT Category II code 3100F to report circumstances when the action described in the numerator is not performed and the reason is not otherwise specified.
3100F with 8P: Carotid imaging study report did not include direct or indirect reference to measurements of distal internal carotid diameter as the denominator for stenosis measurement, reason not otherwise specified.
Hope, this article helps you code CPT code for carotid Doppler studies. If you liked the article, do share it.

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Physician Quality Reporting System (PQRS) used for CPT code 93880 & 93882

Measure 195 Radiology: Stenosis Measurement in Carotid Imaging Reports

CPT Codes
CodeModifierPOSDescription
36222Selective catheter placement, common carotid or innominate artery, unilateral, any approach, with angiography of the ipsilateral extracranial carotid circulation and all associated radiological superv
70498Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and image postprocessing
70547Magnetic resonance angiography, neck; without contrast material(s)
70548Magnetic resonance angiography, neck; with contrast material(s)
70549Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further sequences
93880Duplex scan of extracranial arteries; complete bilateral study
93882Duplex scan of extracranial arteries; unilateral or limited study
3100FCarotid imaging study report (includes direct or indirect reference to measurements of distal internal carotid diameter as the denominator for stenosis measurement) (STR, RAD)
3100F8PCarotid imaging study report (includes direct or indirect reference to measurements of distal internal carotid diameter as the denominator for stenosis measurement) (STR, RAD)
3100FCarotid imaging study report (includes direct or indirect reference to measurements of distal internal carotid diameter as the denominator for stenosis measurement) (STR, RAD)
3100F8PCarotid imaging study report (includes direct or indirect reference to measurements of distal internal carotid diameter as the denominator for stenosis measurement) (STR, RAD)

 

 

Other related CPT codes for Carotid doppler

Abdomen exam complete with doppler – CPT code 76700 , 93975

Kidney or Renal exam with doppler – CPT code 76770, 93975

Renal transplant exam with doppler – CPT code 76776

Renal Transplant exam without doppler- CPT code 76775

Penile Doppler Exam – CPT code 93980

Penile Doppler Exam follow up or Limited – CPT code 93981

Transcranial Doppler  exam complete – CPT code 93986

Transcranila Doppler exam Limited – CPT code 93888

Venous Doppler exam, Extremity bilateral – CPT code 93970

Venous Doppler exam, Extremity unilateral- CPT code 93971

 

ICD 10 Codes covered for CPT code 93880 and 93882

Occlusion & stenosis of right carotid artery

I65.22

Occlusion & stenosis of left carotid artery

I65.23

Occlusion & stenosis of bilateral carotid arteries

I65.29

Occlusion & stenosis of unspecified carotid arter

R09.89

Other spec symptoms and signs involving the circulatory and respiratory systems

R42

R40.4

Transient alteration of awareness

R55

R26.0

R26.1

R26.81

R26.89

Other abnormalities of gait and mobility

R26.9

Unspecified abnormalities of gait and mobility

R27.0

R27.8

Other lack of coordination

R27.9

Unspecified lack of coordination

R20.0

R20.1

R20.2

R20.3

R20.8

Other disturbances of skin sensation

R20.9

Unspecified disturbances of skin sensation

G45.4

H81.41

Vertigo of central origin, right ear

H81.42

Vertigo of central origin, left ear

H81.43

Vertigo of central origin, bilateral

H81.49

Vertigo of central origin, unspecified ear

H34.01

Transient retinal artery occlusion, right eye

H34.02

Transient retinal artery occlusion, left eye

H34.03

Transient retinal artery occlusion, bilateral

I67.89

Other cerebrovascular disease

R68.89

Other general symptoms and signs

H34.211

Partial retinal artery occlusion, right eye

H34.212

Partial retinal artery occlusion, left eye

H53.451

Other localized visual field defect, right eye

H53.452

Other localized visual field defect, left eye

H53.453

Other localized visual field defect, bilateral

H53.459

Other localized visual field defect, unspecified eye

H93.11

H93.12

H93.13

I69.092

Facial weakness following nontraumatic subarachnoid hemorrhage

I69.192

Facial weakness following nontraumatic intracerebral hemorrhage

I69.392

Facial weakness following cerebral infarction

I69.892

Facial weakness following other cerebrovascular disease

I69.992

Facial weakness following unspecified cerebrovascular disease

R41.9

Unspecified symptoms and signs involving cognitive functions and awareness

R45.84

R47.1

H35.61

Retinal hemorrhage, right eye

H35.62

Retinal hemorrhage, left eye

H35.63

Retinal hemorrhage, bilateral

H53.121

Transient visual loss, right eye

H53.122

Transient visual loss, left eye

H53.123

Transient visual loss, bilateral

H53.2

I63.031

Cerebral infarction due to thrombosis of right carotid artery

I63.032

Cerebral infarction due to thrombosis of left carotid artery

I63.039

Cerebral infarction due to thrombosis of unspecified carotid artery

I63.131

Cerebral infarction due to embolism of right carotid artery

I163.132

Cerebral infarction due to embolism of left carotid artery

I63.139

Cerebral infarction due to embolism of unspecified carotid artery

I63.231

Cerebral infarction due to unspecified occlusion or stenosis of right carotid arteries

I63.232

Cerebral infarction due to unspecified occlusion or stenosis of left carotid arteries

I63.239

Cerebral infarction due to unspecified occlusion or stenosis of unspecified carotid arteries

I69.098

Other sequelae following nontraumatic subarachnoid hemorrhage

I69.198

Other sequelae of nontraumatic intracerebral hemorrhage

I69.298

Other sequelae of other nontraumatic intracranial hemorrhage

I69.398

Other sequelae of cerebral infarction

R41.0

Disorientation, unspecified

R41.82

Altered mental status, unspecified

G44.1

Vascular headache, not elsewhere classified

R47.01

R94.39

Abnormal result of other cardiovascular function study

G45.0

Vertebro-basilar artery syndrome

H53.139

Sudden visual loss, unspecified eye

H53.10

Unspecified subjective visual disturbances

R29.5

G81.91

Hemiplegia, unspecified affecting right dominant side

G81.92

Hemiplegia, unspecified affecting left dominant side

G81.93

Hemiplegia, unspecified affecting right nondominant side

G81.94

Hemiplegia, unspecified affecting left nondominant side

R47.02

R47.81

R47.89

Other speech disturbances

G45.8

Other transient cerebral ischemic attacks and related syndromes

Z01.810

Encounter for preprocedural cardiovascular examination

Z48.812

Encounter for sugical aftercare following surgery on the circulatory system

 

Question Categories:

General

Clinical and Billing

Report Specifics

General

What is the purpose of a comparative billing report (CBR)?

The purpose of CBR201604 is to inform and educate providers about their billing and payment patterns for non-invasive vascular studies for Medicare beneficiaries. The CBR team reviewed only Fee-for-Service Medicare (Original Medicare) claims of providers who billed for these services. For more information about CBRs, please visit our website link titled, Comparative Billing Reports.

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Why was this topic chosen for a CBR?

Non-invasive vascular studies were selected as a topic for CBR201604 because a recent study by National Government Services (NGS) identified a large number of claims for non-invasive vascular studies lacked the supporting documentation required by LCD L33627. Also, an investigation by the Office of Inspector General (OIG) found large variations in billing patterns for ultrasound services and determined ultrasound to be an area vulnerable to fraud, waste, and abuse.

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What is the specific focus of the CBR?

CBR201604 focuses on providers of all specialties, excluding radiologists, who rendered services and submitted claims for non-invasive vascular studies using current procedural terminology (CPT®) codes 93880, 93882, 93925, 93926, 93970, and 93971. The measures for this report include the average services per beneficiary for a one-year period and the percentage of consecutive services (billed within 24 hours of another service). If you did not receive a CBR letter and wish to review a sample of a mock provider, please visit the CBR website at the following link: CBR201604 Sample CBR.

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What are the CPT® codes included in this CBR?

The CPT® codes included in this CBR are:  93880, 93882, 93925, 93926, 93970, and 93971. Please refer to the CPT® 2014 and 2015 Professional Edition manuals for complete descriptions of the CPT® codes, which can be accessed from the American Medical Association (AMA) website at the link, AMA Store.

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How many providers received CBR letters?

After claims were pulled and the data evaluated for the CPT® codes listed above, CBRs were sent to approximately 3,900 Medicare Part B providers of CPT® codes for non-invasive vascular studies. The CBR contains a provider’s billing history and patterns and compares them to his/her peers. A mock provider’s CBR can be reviewed at the following link: CBR201604 Sample CBR.

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Does receiving a CBR mean that I am billing incorrectly?

Receiving a CBR does not mean that claims are being billed incorrectly; however, it does mean that your billing is different from your peers. We recognize that practice and billing patterns may vary because of elements that are not evident in the claims data reviewed, such as the region, subspecialty, and patient acuity levels. If you have questions and/or concerns about the CBR received, please contact the CBR Support Help Desk by telephone 1-800-771-4430 or by email at CBRSupport@eglobaltech.com.

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Will providers be audited based on the results of the CBR?

No. Providers will not be audited by the CBR team, as we do not perform any audits. Additionally, we do not have access to nor review medical records. The purpose of the CBR is to allow a provider to compare his/her billing patterns to those of his/her peers; however, it may be beneficial for providers to conduct self-audits. For resources that can help with setting up an audit process, please visit our CBR website page at the link titled, Self-Audit Help.

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Clinical and Billing

What are non-invasive vascular studies?

CGS Administrators define non-invasive vascular studies in LCD L34045 as follows: “Non-invasive vascular studies utilize ultrasonic Doppler and physiologic principles to assess irregularities in blood flow in arterial and venous systems. The display may be a two dimensional image with spectral analysis and color flow or a plethysmography recording. For the purposes of this policy, non-invasive vascular studies include duplex scans, physiologic studies and plethysmography.”

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What is involved in a non-invasive vascular study?

A description of non-invasive vascular studies found in CGS Administrators LCD L34045 states: “Non-invasive vascular studies utilize ultrasonic Doppler and physiologic principles to assess irregularities in blood flow in arterial and venous systems. The display may be a two dimensional image with spectral analysis and color flow or a plethysmographic recording. For the purposes of this policy, non-invasive vascular studies include duplex scans, physiologic studies and plethysmography.”

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What are the different types of non-invasive vascular studies?

There are three distinct types of non-invasive vascular studies: duplex scans of extracranial arteries, duplex scans of lower extremity arteries or arterial bypass grafts, and duplex scans of extremity veins, including responses to compression and other maneuvers.

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Where can I find information regarding medical necessity?

According to National Government Services (NGS) LCD L33627 regarding general indications, “Non-invasive vascular studies are considered medically necessary if the ordering physician has reasonable expectation that their outcomes will potentially impact the clinical management of the patient. Services are deemed medically necessary when the following conditions are met:

• Significant signs/symptoms of arterial or venous disease are present;

• The information is necessary for appropriate medical and/or surgical management; and/or

• The test is not redundant of other diagnostic procedures that must be performed.

In general, non-invasive studies of the arterial system are utilized when invasive correction is contemplated. It is the responsibility of the physician/provider to ensure the medical necessity of procedures and documentation of such in the medical record.”

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Where can I find Medicare guidelines for non-invasive vascular tests that are NOT considered medically necessary?

First Coast Service Options (FCSO) LCD L33667 states the following regarding this procedure: “Noninvasive vascular testing studies are medically necessary only if the outcome will potentially impact the clinical management of the patient. For example, if a patient is (or is not) proceeding on to other diagnostic and/or therapeutic procedures regardless of the outcome of non-invasive studies, and non-invasive vascular procedures will not provide any unique diagnostic information that would impact patient management, then the non-invasive procedures are not medically necessary. If it is obvious from the findings of the history and physical examination that the patient is going to proceed to angiography, then non-invasive vascular studies are not medically necessary. It is also expected that the studies are not redundant of other diagnostic procedures that must be performed.” For more details, please refer to FCSO LCD found at the following link: LCD L33667. To find the LCD for your Medicare Administrative contractor (MAC), see the references and resources on the CBR page at CBR201604 Recommended Links.

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What are the conditions that may indicate carotid testing is needed?

Please check the LCD associated with your MAC for more in-depth information; however, some common indications for carotid duplex studies (CPT® codes 93880 and 93882) for most MACs include the following:

• Bruits

• Recent stroke

• Symptomatic carotid stenosis

• Carotid artery injury/neck trauma

• Suspected aneurysm/dissection

• Post-carotid endarterectomy monitoring

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What are the indications for peripheral arterial evaluations?

Please check the LCD for your MAC for any additional indications; however, the below indications for peripheral arterial studies (CPT® codes 93925 and 93926) were taken from Noridian Healthcare Solution’s LCD L34219 and include:

• Claudication (limiting lifestyle)

• Rest pains usually associated with diminished or absent pulses

• Tissue loss defined as gangrene or pre-gangrenous changes

• Ischemic ulcerations occurring with diminished or absent pulses

• Aneurysmal disease

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Where can I find billing guidelines for my region?

The coverage and documentation guidelines for non-invasive vascular studies for MACs are listed on the CBR201604 Recommended Links page. Please follow the LCD links to the guidelines for your region:

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What are some reasons for denial of non-invasive vascular studies?

NGS notes the following reasons for denial of non-invasive vascular studies:

• Missing or illegible provider signature

• No response to request for documentation

• Documentation submitted was not for CPT® codes billed

• Incomplete/missing beneficiary information

• Documentation submitted shows rendering physician on claim form was not the physician who performed the services

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Report Specifics

How was a peer defined for this CBR?

 A peer was defined as a single rendering provider, as identified by National Provider Identifier (NPI). Peer groups for comparison with an individual provider are listed below:

• State: All Medicare Part B providers of all specialties (excluding radiologists) located in the provider’s state who submitted claims with CPT® codes 93880, 93882, 93925, 93926, 93970, and 93971

• National: All Medicare Part B providers of all specialties in the nation (excluding radiologists) with claims and allowed charges for CPT® codes 93880, 93882, 93925, 93926, 93970, and 93971

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What do the comparison outcomes mean?

The four possible outcomes for the comparisons between the provider and peer groups are:

• Significantly Higher - provider’s value is higher than the peer value and the statistical test used confirms significance

• Higher - provider’s value is higher than the peer value but either the statistical test does not confirm a significance or there is insufficient data for comparison

• Does Not Exceed - provider’s value is not higher than the peer value

• N/A (Not applicable) - provider does not have data for comparison

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My allowed charges are higher than the national averages. Are my allowed charges being compared to providers in other states that have lower allowed charges?

Please be aware that having higher allowed charges than your peers does not necessarily indicate any wrong-doing on your part.  We understand that the Medicare Physician Fee Schedule (MPFS) allowed amounts vary from area to area. To account for the variation in practice expenses across the states and nation, a Geographic Practice Cost Index (GPCI) has been established.

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Can you explain what Table 1 means?

Table 1 is titled, Summary of Your Utilization. The first column lists the CPT® codes included in this analysis. The second column titled, Description, provides a short explanation of each CPT® code. The last four columns provide the total Allowed Charges, Allowed Services, Consecutive Services and distinct Beneficiary Count for each CPT® code. To help illustrate Table 1, see the mock provider’s sample CBR at the link, CBR201604 Sample CBR.

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What does Table 2 mean?

Table 2 is an example of the Average Allowed Services per Beneficiary. To help illustrate this, refer to Table 2 of the mock provider’s sample at the link, CBR201604 Sample CBR. In the Table, the provider’s average allowed services per beneficiary were 1.19. His state’s average allowed services per beneficiary is 1.22, and the national average allowed services per beneficiary is 1.23. This provider’s average Does Not Exceed either the state’s average or the national average allowed charges per beneficiary. The results for each state and the nation can be viewed at the link, CBR201604 Statistical Debriefing.

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What does Table 3 mean?

Table 3 is an analysis of the Percentage of Consecutive Services. The percentage of consecutive services was calculated by flagging any service provided within 24 hours of another service by the same provider and beneficiary. For an illustration, refer to the mock provider’s CBR letter at the following link:CBR201604 Sample CBR. In this example, 19 percent of the provider’s total services were consecutive services. This percentage was calculated by dividing the total number of consecutive services (472) by the total number of beneficiaries (2,482), and then multiplied by 100, which yielded 19. This was Significantly Higher than the state’s average of four percent and the national average of 11 percent. To view the percentages for each state and the nation, see the following link: CBR201604 Statistical Debriefing.

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