Radiology Coding Alert

Question: If we perform extremity arterial vascular studies (93922-93923) on the left leg and arm, how should I code this?

Ohio Subscriber

Answer: The particular modifiers you use will depend on payer preference, but there are some guidelines you can use to get you on your way to accurate coding.

Unilateral: The case you describe involves studying only one side of the body (unilateral). The codes for the service represent bilateral services (emphasis added):

• 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)
• 93923 -- Noninvasive 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).

Because you aren't reporting the full service as defined, you'll need to append modifier 52 (Reduced services) to the service code.

Multiple limbs: The use of the word "or" in the descriptor (... studies of upper or lower extremity arteries ...) indicates you should report 93923 once for the arms and once for the legs, according to CPT Assistant (June 2001). You can apply the same logic to 93922.

Exactly how you report multiple services will depend on your payer. For example, for the second service, the payer may ask you to append modifier 59 (Distinct procedural service) or modifier 76 (Repeat procedure or service by same physician), although an arm service doesn't technically "repeat" a leg service.