Per the August 2009 CPT Assistant:
Originally Posted by barber
Codes 93922, 93923, and 93924 may involve functional measurement procedures, including ankle/brachial index measurement (ABI), blood pressure (BP) and physiologic waveforms, segmental pressure measurement, plethysmography, and stress testing.
These studies do not involve imaging because they are performed using equipment that is separate and distinct from the duplex scanner. The most common is the ABI test, which uses a Doppler stethoscope to measure sound within the vessels at the ankle or the elbowâ€™s antecubital fossa. Doppler velocity signals, called waveforms, can be measured to localize vascular disease at a single level (93922) or at segmental (various) limb levels (93923). Exercise testing can be used to analyze the functional significance of vascular disease by reassessing the blood pressure with the Doppler stethoscope, after completion of an appropriate amount of stress testing (93924).
Note: The use of a simple hand-held or other Doppler device that does not produce hard copy output, or that does not permit analysis of bi-directional vascular flow, is considered to be part of the evaluation and management (E/M) service (physical examination) and is not separately reportable.
Bi-directional Doppler studies are not the only type of noninvasive physiologic study. Some do not rely upon Doppler at all. Plethysmography is a measurement of the volume of an organ or limb section or flow rate, in response to the inflation and deflation of a specially calibrated blood pressure cuff. Transcutaneous oxygen tension measurement which is typically performed on the foot or calf, measures the influx of blood providing oxygen for diffusion to the skin in the area of study.
Code 93922 represents a noninvasive physiologic arterial study of either both upper extremities (UE) or both lower extremities (LE) performed at only one level of the involved extremities. An example of a single level study is an evaluation of non-imaging physiologic recordings of pressures, Doppler analysis of bi-directional blood flow, plethysmography, and/or oxygen tension measurements at each ankle. Again, if this evaluationdoes notproduce hard copy output or, for Doppler testing produces a record that does not permit analysis of bi-directional blood flow direction, then the evaluation is considered to be part of the part of the E/M service and is not separately reportable.
Hope this helps,
Lucinda (Cindy) McGarry, CPC-P
Avera Health Plans
Education Office Sioux Falls SD Local Chapter
Past President Sioux Falls SD Local Chapter