Modifier Use and Same-Day Vascular Ultrasound Services

Question:

I have a question regarding the appropriate use of modifiers when billing for E/M services performed on the same day as ultrasound procedures (e.g., 93880, 93922, 93978, etc.). Our billing team has been consistently appending modifier 25 to all E/M visits that coincide with same-day ultrasounds, and applying modifier 59 to each ultrasound code. We are a private practice and own the ultrasound equipment, so we do not use modifiers 26 or TC. Could you please confirm whether this approach is correct? Specifically, is it appropriate to routinely apply both modifier 25 to the E/M service and modifier 59 to the ultrasound codes for all in-office visits involving same-day ultrasounds? Thank you in advance for your guidance!

Answer:

Based on NCCI data, there are no procedure-to-procedure edits between office visits and vascular ultrasound codes such as 93880, 93922, or 93978, meaning these services are not inherently bundled and may be reported together when medically necessary and supported by documentation.

Because there are no NCCI conflicts, the use of modifiers 25, 59, or XU is not required for these code combinations. However, some payers may still require one or more of these modifiers for claims processing or system recognition when an E/M service and diagnostic ultrasound are performed on the same day.

It is important to review individual payer policies to determine when modifiers 25, 59, or XU may be necessary to ensure accurate claim submission and avoid denials.

*This response is based on the best information available as of 12/18/25.

Reporting 36015

Question:

We have seen some illustrations suggesting the maximum number for reporting 36015 in one session is 5 (3-right(U,M,L), 2 Left(U,L). This method only counts the lobar arteries and excludes counting the segmental arteries. Is it your opinion that each segmental artery can be individually reported? For example, if the provider performed selective catheterization on the right side of the medial basal segment, the posterior basal segment and the lateral basal segment would this count as three (3) total under the lower lobe or count as one (1) since all are in the lower lobe?

Answer:

You can bill 36015 for each distinct selective catheterization, but only when those vessels are legitimately separate branches per the CPT Appendix L vascular-family hierarchy.

Segmental or subsegmental arteries within the same lobar distribution are not separately reportable; they are included in a single unit of 36015 for that lobe. Therefore, selective catheterization of the medial basal, posterior basal, and lateral basal segmental branches would count as one (1) selective catheterization under the right lower-lobe pulmonary artery, not three.

*This response is based on the best information available as of 12/04/25.

E/M During Global Period for Diabetic Foot Ulcer Following Total Metatarsal Amputation

Question:

If a patient has a total metatarsal amputation for diabetic foot ulcer and he gets readmitted for another condition, but then vascular surgery is consulted for his original underlying condition of DFA and now is treating the ulcer at the amputation site, 80 days post-op is the E/M billable? The TMA surgical wound is healing. The right plantar DFU stage 3 Wagner needs debridement and dressing changes.

Answer:

The evaluation and management service is not separately billable because it appears to represent continued management of the same surgical and disease process that prompted the original total metatarsal amputation. Any care directed toward the amputation wound or related diabetic ulceration in the same region during the 90-day global is included in the global period.

*This response is based on the best information available as of 11/20/25.

Clarifying +G2211

Question:

My question is whether +G2211 is appropriate for vascular surgeons. Since the code has now been implemented, I’m wondering if it’s considered appropriate for those of us who manage long-term vascular patients over several years to use this add-on code until further guidance or changes occur.

Answer:

The add-on code +G2211 is not restricted by specialty and may be reported by any provider when the visit meets the required criteria. However, many interpretations suggest that the intent of the code is more closely aligned with primary care and the ongoing, relationship-based management of chronic or complex conditions, rather than procedural or single-episode care.

To use +G2211, the encounter must involve an office or outpatient E/M service (99202–99215) and reflect longitudinal or continuous care for a serious or complex condition. Documentation should support that the provider serves as a continuing focal point in the patient’s management and that the care provided extends beyond routine or acute treatment.

Because the code allows interpretive flexibility, its use in procedural specialties may carry a higher risk of audit or scrutiny.

*This response is based on the best information available as of 11/06/25.

Catheter with Angioplasty Procedure

Question:

If a third-order catheter is pulled back and enters the iliac, which is then treated with angioplasty, can you code that selective iliac catheterization in addition to the angioplasty?

Answer:

​No, because catheterization is inclusive to lower extremity arterial revascularization interventions, such as an arterial angioplasty and stenting. Report the angioplasty only.

*This response is based on the best information available as of 10/23/25.

How Do You Bill for H&P on the Same Date as an EVAR?

Question:

I saw a patient in the office, performed an examination, and scheduled an EVAR for the next week in the hospital.  The day of surgery, the hospital requires that I document an H&P on the day of the procedure. Can I bill an E/M for the required H&P?

Answer:

Thank you for reaching out to KZA! Because the EVAR procedure has a 90-day global period, it is considered a major procedure.  You cannot bill a separate E/M service for the history and physical on the day of the EVAR procedure if it's solely the pre-procedure H&P required for hospital admission/surgery.

Chapter 1 of the National Correct Coding Initiative states: “If a procedure has a global period of 90 days, it is defined as a major surgical procedure. If an E&M is performed on the same date of service as a major surgical procedure for the purpose of deciding whether to perform this surgical procedure, the E&M service is separately reportable with modifier 57. Other E&M services on the same date of service as a major surgical procedure are included in the global payment for the procedure and are not separately reportable”

*This response is based on the best information available as of 10/09/25.