Radiology Coding Alert

Know 93922's and 93923's requirements to determine when you can ethically report these codes -- and when you can't

If you didn't realize that you could report two units of CPT 93923 when your physician performs both upper and lower extremity arterial studies on the same date, you could be losing money.

According to Medicare data, radiologists perform or interpret more than 65,000 peripheral arterial physiologic studies a year. Although your radiologist may consider these procedures routine, coding 93922, 93923 and other arterial studies can be a challenge. Our expert tips can guide your extremity ultrasound coding so you can collect accurate reimbursement every time.

Tip 1:Unilateral Study Warrants Modifier -52

Radiologists often perform non-invasive physiologic studies of the extremities. The two most commonly-reported codes for these procedures follow:

93922 -- Non-invasive physiologic studies of upper or lower extremity arteries, single level, bilateral (e.g., ankle/brachial indices, Doppler waveform analysis, volume plethysmography, transcutaneous oxygen tension measurement)

93923 -- Non-invasive physiologic studies of upper or lower extremity arteries, 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)

If you perform a unilateral upper or lower extremity physiologic arterial study, always append modifier -52 (Reduced services) to 93922 or 93923, or you could be accused of overcoding the service. Because 93922 and 93923 represent inherently bilateral procedures, modifier -52 is your key to unlocking unilateral reimbursement, says Bruce Hammond, CRA, CMNT, chief operating officer at Diagnostic Health Services Inc., a Texas-based radiology imaging service with locations in 15 states.

Most Medicare carriers explain this guideline in their policies. According to Iowa Medicare's local coverage determination, these studies "are reimbursed on a bilateral basis unless specified. AModifier -52 should be used for unilateral when a CPT Code indicating a bilateral study is submitted."

Avoid this mistake: Some coders may be tempted to report 93926 (Duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or limited study) for unilateral studies because they may quickly scan the descriptors in CPT's "Extremity Arterial Studies" section and spy, "93926...unilateral or limited study." But you should report 93926 only if your physician performs the duplex scan. This code does not apply to the non-invasive physiologic studies that 93922 and 93923 describe.

Tip 2:Watch Your Diagnoses

If your radiologist performs an extremity arterial physiologic study along with an extremity duplex scan, you won't always be able to collect for both studies. Although the National Correct Coding Initiative does not bundle 93922 and 93923 into the duplex scan codes (93925-93931), most payers will reimburse you for both services on the same date only if your patient suffers from very specific arterial diagnoses. Apolicy from Palmetto GBA, a Part B carrier in South Carolina, states, "When CPT codes 92922-93923 and CPT codes 93925-93931 are submitted for the same date of service, the physiologic study will be denied as not medically necessary," unless your medical record includes one of the following conditions:

442.0 -- Other aneurysm of artery of upper extremity

442.3 -- Other aneurysm of artery of lower extremity

442.82 -- Other aneurysm of subclavian artery

444.21 -- Arterial embolism and thrombosis of upper extremity

444.22 -- Arterial embolism and thrombosis of lower extremity

794.30 -- Nonspecific abnormal results of function tests; Abnormal function study, unspecified

903.00-904.9 -- Injury to blood vessels of extremities

V58.73 -- Aftercare following surgery of the circulatory system, NEC

Other carriers may require different diagnoses, so check your local payer's policy.

Tip 3:Upper,Lower Extremities? Report Two Units

Suppose a patient presents with a vascular surgeon's order to perform single-level segmental Doppler waveform analyses of both the upper and lower extremities. Should you report one unit of 93922, or should you append a modifier to denote that the physician studied more than one extremity?

Because 93922's descriptor notes "upper or lower extremity arteries," the code does not include studies of more than one extremity. According to the June 2001 CPT Assistant, if the physician performs complete studies on two extremities, you should report two units of the code, "once for the upper extremities and once for the lower." Your carrier should not require you to append any modifiers.

Tip 4:Include Hand-Held Dopplers in E/M Charges

If your physician uses a hand-held Doppler device to measure a patient's ankle/brachial index (ABI), you cannot report 93922-93923. Although some coders see the reference to "ankle/brachial indices" in 93922's descriptor, this does not mean that you can report this code for devices that do not produce hard-copy output, such as the Pocket-Dop II or the Elite device.

"If the device does not permit analysis of biodirec-tional vascular flow or produce hard-copy output, insurers will consider the use of a simple hand-held device as part of the vascular system exam and will not separately reimburse it," says Roseanne R. Wholey, president of Roseanne R. Wholey and Associates, a medical reimbursement consulting firm in Oakmont, Pa.