Duplex charges for scrotal, pelvic, transvaginal and obstetric ultrasounds

Q.

May we add duplex charges to scrotal, pelvic, transvaginal, and obstetric ultrasounds?

A.

If a duplex scan is ordered, medically necessary, and performed with those ultrasound exams then both the “regular” (i.e., grayscale) ultrasound code and the duplex scan may be reported. However, more often than not, especially for scrotal ultrasounds, a full-duplex is not done – only color Doppler is performed. That is not separately reportable.

A duplex scan requires grayscale imaging of the vascular structure (as opposed to the parenchyma of the organ), color doppler, and spectral analysis. Color doppler alone is not a separately billable service.

In a hospital location (including outpatient hospital), if not ordered by the patient’s treating/ordering physician, the radiologist may determine that a duplex scan is medically necessary. However, the radiologist must either order the exam or document the intent to do the exam and document the medical necessity for the individual patient. In other words, you can’t do a duplex for every patient that comes in for scrotal, pelvic, ovarian, OB, etc.

In a non-hospital situation, you would need to get an order from the referring physician unless you can’t reach the ordering physician, and not doing the exam right then would be dangerous to the patient. That must all be documented.