Radiology Coding Alert

When your radiologist performs an extremity arterial physiologic study on the same date as an extremity duplex scan, you have to dig deep to be sure you're coding correctly. Correct Coding Initiative (CCI) edits don't bundle 93922 and 93923 into duplex scan codes (93925-93931), but payers may not consider both services necessary unless the patient has specific diagnoses.

For example, Noridian's "Noninvasive Peripheral Arterial Studies" local coverage determination (L24339) states, "Duplex scanning and physiologic studies are reimbursed during the same encounter if the physiologic studies are abnormal and/or to evaluate vascular trauma, thromboembolic events or aneurysmal disease."

You also have support from the American College of Radiology (ACR) in the July/August 2006 Coding Source, notes Stacie L. Buck, RHIA, CCS-P, LHRM, RCC, CIC, president and senior consultant of RadRx in Stuart, Fla.

The Coding Source states that when the radiologists performs a duplex Doppler of the lower extremities as well as ankle/brachial indices (ABIs), reporting 93925 (Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study) for the duplex scan and 93922 (Noninvasive 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]) for the ABI is appropriate.

Reason: The equipment for the noninvasive physiologic studies is separate and distinct from the duplex scanner, as the CPT guidelines for Noninvasive Vascular Diagnostic Studies point out.

"Duplex" indicates that the radiologist performed imaging, points out the January/February 2007 ACR Coding Source. ABIs -- and all services 93922 and 93923 (Noninvasive physiologic studies ...) describe

Keep these aspects of the new form in mind: