Cardiology Coding Alert

Question: When can I report ABIs separately and when should I include them in the office visit services?

California Subscriber

Answer: You typically should include an ankle/brachial index (ABI) test in office-visit services when the provider performs the ABI without other vascular studies. In addition, CPT's Noninvasive Vascular Diagnostic Studies guidelines say, "The use of a simple hand-held device that does not produce hard copy output, or that produces a record that does not permit analysis of bidirectional vascular flow, is considered to be part  of the physical examination of the vascular system and is not separately reported."

Payer policy: Payers may not consider an ABI alone sufficient for 93922 (Noninvasive physiologic studies of upper or lower extremity arteries, single level, bilateral [eg, ankle/brachial indices, Doppler waveform analysis, volume plethysmography, transcutaneous oxygen tension measurement]). For example,  Palmetto GBA, California's Part B contractor, says, "CPT 93922 must include the ABIs and at least one of the other elements of the code."

Related code 93923 (... multiple levels or with provocative functional maneuvers, complete bilateral study [e.g., segmental blood pressure measurements, segmental Doppler waveform analysis, segmental volume plethysmography, segmental transcutaneous oxygen tension measurements, measurements with postural provocative tests, measurements with reactive hyperemia]) may have added rules, too. For example, Palmetto's policy offers specific criteria you must meet before reporting 93923. You can search policies online at www.cms.gov/mcd/overview.asp.

Money talks: The Medicare fee schedule lists 3.23 transitioned non-facility total relative value units (RVUs) for 93922. Multiply that by the 36.0846 2010 conversion rate, and you see Medicare pays roughly $117 for 93922, before adjusting for regional differences. If you report 93923 correctly, its 4.97 transitioned non-facility RVUs mean you'll receive roughly $179.

ICD-9 tip: Your LCD may also offer diagnosis codes that support medical necessity for these studies. For example, the Palmetto LCD lists several diagnoses, such as 440.21 (Atherosclerosis; of native arteries of the extremities; atherosclerosis of the extremities with intermittent claudication).