Meet These 93922, 93923 Must-Haves or Risk Repaying $186
Posted on 15. Jan, 2009 by Editor in Hot Coding Topics
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Robert Ross
11. Mar, 2010
What is your interpretation on who can do 93922, 93923 & 93924 physiologic ultrasound tests based on the WPS Utilization guidelines?
Utilization Guidelines
A. Training and Certification
1. The accuracy of non-invasive vascular diagnostic studies depends on the knowledge, skill, and experience of the technologist and interpreter. Consequently, the physician performing and/or interpreting the study must be capable of demonstrating documented training and experience and maintain any applicable documentation. A vascular diagnostic study may be personally performed by a physician or a technologist.
The GAO Report to Congressional Committees entitled Medicare Ultrasound Procedures. Consideration of Payment Reforms and Technician Qualifications Requirements states that “Findings from several peer-reviewed studies, the Medicare Payment Advisory Commission, and ultrasound-related professional organizations support requiring that sonographers either have credentials or operate in facilities that are accredited, where specific quality standards apply. In some localities and practice settings, CMS or its contractors have required that sonographers either be credentialed or work in an accredited facility.” (GAO-07-734)
2. All non-invasive vascular diagnostic studies must be performed under at least one of the following settings:
a. performed by a physician who is competent in diagnostic vascular studies or under the general supervision of physicians who have demonstrated minimum entry level competency by being credentialed in vascular technology, or
b. performed by a technician who is certified in vascular technology, or
c. performed in facilities with laboratories accredited in vascular technology.
3. One or more technologists in each vascular laboratory must be certified by a credentialing board recognized by the Intersocietal Commission for Accreditation of Vascular Laboratories (ICAVL) or the National Council for Certifying Agencies (NCCA) or the International Standards Organization (ISO) 17024).
4. Laboratories may be certified by the Intersocietal Commission for the Accreditation of Vascular Laboratories. Certification of the laboratory itself supersedes the requirement for certification of individual technologists.
If a certified technologist supervises technologists who are not certified, the certified RVT must: provide direct supervision; and sign the record of the test and attest to the quality of the examination
These requirements will be necessary to payment of services provided beginning 05/01/2010.
Robert Ross
11. Mar, 2010
This is the interpretation from WPS.
Dear Mr. Ross,
Thank you for the inquiry you sent to Wisconsin Physicians Service (WPS) Medicare regarding Local Coverage Determination (LCD) L28586, “Noninvasive Vascular Testing (N.I.V.T.).”
This is a follow-up to our telephone call on January 11, 2010. WPS Medicare follows the utilization guidelines in LCD L28586. A qualified physician or qualified technologist must perform vascular studies. Beginning May 1, 2010, the LCD requirements mandate if a certified technologist supervises non-certified technologists, the registered vascular technologist (RVT) must provide direct supervision, sign the record of the test and attest to the quality of the examination. The LCD, in part, states the following:
“All non-invasive vascular diagnostic studies must be performed under at least one of the following settings:
· Performed by a physician who is competent in diagnostic vascular studies or under the general supervision of physicians who have demonstrated minimum entry level competency by being credentialed in vascular technology, or
· Performed by a technician who is certified in vascular technology, or
· Performed in facilities with laboratories accredited in vascular technology”
As you are probably aware, according to the Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule (PFS) Relative Value File (RFV), the physician must personally perform the global service and the professional component. The qualified technologist may perform the technical component. You may access the Medicare PFS RVU on the following CMS Website:
http://www.cms.hhs.gov/PhysicianFeeSched/PFSRVF/list.asp?listpage=4
During our conversation, you indicated you wanted WPS Medicare to address our statement concerning physicians and technologists performing and/or interpreting diagnostic tests for procedure codes 93922-TC, 93922-26; 93923-TC, 93923-26, 93924-TC, 93924-26, 93965-TC, and 93965-26. You asked WPS Medicare to address four questions regarding the above-referenced LCD L28586.
I forwarded your inquiry to a member of our Medical Policy staff for assistance with answering your question. For the sake of clarity, I will restate each of your questions followed by Medical Policy staff answer.
Question 1: In a clinic setting having only family practice physicians and/or internal medicine physicians, must these physicians performing the supervision have to demonstrate that they meet the minimum entry level competency by being credentialed in vascular technology?
Answer 1: No, if the services are performed by a technician who is certified in vascular technology, or performed in facilities with laboratories accredited in vascular technology, the supervising physician does not have to demonstrate that he/she meets the minimum entry level competence by being credentialed in vascular technology.
Question 2: Does WPS Medicare permit a medical assistant or anyone else not meeting the qualifications of a certified vascular technician (VT) to perform the technical component in the office setting under the general supervision of a physician?
Answer 2: No.
Question 3: Does a technician have to be certified in vascular technology?
Answer 3: Yes, per the policy requirements listed.
Question 4: How does WPS Medicare define a technician as competent when performing the technical component of the above-referenced diagnostic tests if he/she is not certified?
Answer 4: WPS Medicare does not define a non-certified technician as competent. WPS Medicare requires that the physicians and technologists must meet the criteria listed in the policy.
I hope this information is responsive to your needs. If you need additional assistance from WPS Medicare regarding this matter, please include the reference number below in any correspondence. If immediate assistance is needed, you may reach our Provider Contact Center by calling 866-234-7331.
Sincerely,
Barbara Lawrenz
Provider Relations Research Specialist
WPS Medicare
Robert Ross
11. Mar, 2010
Can the 93922 and 93923 be billed on the same day encounter if a Modifier 59 is applied to the 93923?