Ask Dr. Z

Within the PVL, a written physician order is documented within the patient chart that requests:
• Deep Vein studies/ lower extremity
• Bilateral Carotid Duplex
• Bilateral Lower extremity vein mapping
When these orders are entered from the unit and received within the Radiology order billing system; CPT 93970 is reported for both (venous mapping and Bilateral Lower Extremity Duplex) orders selected (93880, 93970, 93970). Although a distinct service modifier would pass edits, I feel that when performed during the same encounter, the venous mapping is inclusive with the bilateral duplex scan of extremity veins and should not be reported separately. I submit that both technical and professional charges for this encounter should only be reported as 93880 and 93970.
I would respect your opinion on this to support my position for what I feel could be a duplication of procedural charges.

Dictated report for all procedures are provided below:
PROCEDURE: BILATERAL SAPHENOUS VEIN MAPPING
COMPARISON: None.
INDICATION: Pre open heart surgery.
TECHNIQUE: Gray-scale imaging was performed on the bilateral greater saphenous veins with caliber measurements.
FINDINGS:
RIGHT GSV:
Thigh proximal: 2.9 mm
Thigh mid: 3.0 mm
Thigh distal: 2.7 mm
Knee: 2.4 mm
Calf proximal: 1.9 mm
Calf mid: 1.7 mm
Calf distal: 2.2 mm
LEFT GSV:
Thigh proximal: 3.8 mm
Thigh mid: 2.8 mm
Thigh distal: 2.0 mm
Knee: 2.2 mm
Calf proximal: 2.0 mm
Calf mid: 1.5 mm
Calf distal: 1.4 mm
CONCLUSION: The bilateral greater saphenous veins were imaged and measured as described above.

PROCEDURE: BILATERAL LOWER EXTREMITY VENOUS ULTRASOUND FOR DVT WITH DOPPLER
COMPARISON: None.
INDICATION: Previous DVT.
TECHNIQUE: Gray-scale and color Doppler imaging were performed on the bilateral lower extremities.
FINDINGS:
RIGHT LOWER EXTREMITY:
CFV: Normal.
SFV: Reduced.
PFV: Normal.
POP-V: Reduced.
PTV: Normal.
PER: Normal.
ATV: Normal.
GSV: Normal.
LEFT LOWER EXTREMITY:
CFV: Normal.
SFV: Normal.
PFV: Normal.
POP-V: Normal.
PTV: Normal.
PER: Normal.
ATV: Normal.
GSV: Normal.
Normal findings indicate good phasicity, spontaneity, compressibility, augmentation response, and competence.
CONCLUSION: Chronic DVT seen in the right SFV and popliteal vein with recanalization. Remaining deep vessels show no evidence of acute or chronic DVT. No evidence of superficial thrombophlebitis.

PROCEDURE: BILATERAL CAROTID DUPLEX ULTRASOUND
COMPARISON: None.
INDICATION: Preop screening.
HISTORY: CAD.
TECHNIQUE: Gray-scale and color Doppler imaging were performed on the bilateral carotid arteries.
FINDINGS:
RIGHT:
COMMON CAROTID ARTERY:
PLAQUE MORPHOLOGY: Heterogenous.
SURFACE CHARACTERISTICS: Smooth.
FLOW CHARACTERISTICS: Laminar
PEAK SYSTOLIC VELOCITY: 80 cm/s
END-DIASTOLIC VELOCITY: 17 cm/s
PROXIMAL INTERNAL CAROTID ARTERY:
PLAQUE MORPHOLOGY: Heterogenous. Calcified.
SURFACE CHARACTERISTICS: Irregular.
FLOW CHARACTERISTICS: Laminar.
PEAK SYSTOLIC VELOCITY: 207 cm/s
END-DIASTOLIC VELOCITY: 62 cm/s
DISTAL INTERNAL CAROTID ARTERY:
PLAQUE MORPHOLOGY: Heterogenous.
SURFACE CHARACTERISTICS: Smooth.
FLOW CHARACTERISTICS: Laminar.
PEAK SYSTOLIC VELOCITY: 188 cm/s
END-DIASTOLIC VELOCITY: 37 cm/s
EXTERNAL CAROTID ARTERY:
PLAQUE MORPHOLOGY: Heterogenous.
SURFACE CHARACTERISTICS: Smooth.
FLOW CHARACTERISTICS: Laminar.
PEAK SYSTOLIC VELOCITY: 137 cm/s
END-DIASTOLIC VELOCITY: 21 cm/s
VERTEBRAL ARTERY: Antegrade.
ICA:CCA SYSTOLIC RATIO: 2.6
LEFT:
COMMON CAROTID ARTERY:
PLAQUE MORPHOLOGY: Heterogenous.
SURFACE CHARACTERISTICS: Smooth.
FLOW CHARACTERISTICS: Laminar.
PEAK SYSTOLIC VELOCITY: 87 cm/s
END-DIASTOLIC VELOCITY: 21 cm/s
PROXIMAL INTERNAL CAROTID ARTERY:
PLAQUE MORPHOLOGY: Heterogenous. Calcified.
SURFACE CHARACTERISTICS: Irregular.
FLOW CHARACTERISTICS: Turbulent.
PEAK SYSTOLIC VELOCITY: 184 cm/s
END-DIASTOLIC VELOCITY: 54 cm/s
DISTAL INTERNAL CAROTID ARTERY:
PLAQUE MORPHOLOGY: Heterogenous.
SURFACE CHARACTERISTICS: Smooth.
FLOW CHARACTERISTICS: Laminar.
PEAK SYSTOLIC VELOCITY: 162 cm/s
END-DIASTOLIC VELOCITY: 47 cm/s
EXTERNAL CAROTID ARTERY:
PLAQUE MORPHOLOGY: Heterogenous.
SURFACE CHARACTERISTICS: Smooth.
FLOW CHARACTERISTICS: Laminar.
PEAK SYSTOLIC VELOCITY: 157 cm/s
END-DIASTOLIC VELOCITY: 27 cm/s
VERTEBRAL ARTERY: Antegrade.
ICA:CCA SYSTOLIC RATIO: 2.1
CONCLUSION: Bilateral 60-79% ICA stenosis with irregular plaque characteristics and turbulent flow. The vertebral arteries appear patent with antegrade flow bilaterally.