Per AMA/CMS Guidelines, in order to bill for 93922 in the office setting, having performed and interpreted the study, the provider must be a physician that is: "capable of demonstrating documented training through recent residency training or postgraduate Continuing Medical Education (CME) and experience and maintain that documentation for post payment review."
Full Answer
What is Procedure Code 93922?
What is procedure code 93922? CPT codes 93922 and 93923 are assigned for bilateral upper or lower extremity arterial assessments to check blood flow in relation to a blockage. These are typically performed to establish the level and/or degree of arterial occlusive disease.
What is 93923 CPT code?
CPT® Code: 93923 Complete bilateral noninvasive physiologic studies of upper or lower extremity arteries, 3 or more levels. CPT® Code: 93924 Noninvasive physiologic studies of lower extremity arteries, at rest and following treadmill stress testing. ICD-10-CM DIAGNOSIS CODES
What is CPT code 93924?
Draft announcement of CPT 93924 change The CPT Editorial Board has made changes to the description and requirements for CPT Code 93924, which is the code used to describe non-invasive vascular testing with pre-and post-exercise measurements. New CPT code language for 93924 is as follows: 93924: Noninvasive physiologic studies of lower extremity ...
What CPT codes require a qw modifier?
What CPT codes require a QW modifier? The modifier QW CLIA waived check have to be appended to all however a handful of CPT codes to be acknowledged as a waived check. Codes not requiring the QW are 81002, 82270, 82272, 82962, 83026, 84830, 85013, and 85651 . All of the waived exams may be present in CR 11080.
Does Medicare cover CPT 93922?
Medicare expects that one of the “V”-codes listed below be billed as the primary diagnosis when billing CPT/HCPCS codes 93922, 93923, 93924, 93925, 93926, 93930 and 93931 for preoperative examination of patients with clinically suspected vascular disease who will undergo a lower extremity surgical procedure for which ...
Does CPT code 93922 need a modifier?
In 2011, such a situation (three or more levels, unilateral) is now appropriately described by the lesser valued CPT code, 93922. A study which involves one or two levels in a single extremity (unilateral) still requires CPT code 93922 have the -52 modifier appended.
Is ankle brachial index covered by Medicare?
Assessment of the Ankle brachial indices (ABI) only is considered part of the physical examination and is not covered according to Title XVIII of the Social Security Act section 1862 (a) (7) which excludes routine physical examinations and services from Medicare coverage.
What is procedure code 93922?
CPT codes 93922 and 93923 are assigned for bilateral upper or lower extremity arterial assessments to check blood flow in relation to a blockage. These are typically performed to establish the level and/or degree of arterial occlusive disease.
What is the difference between CPT 93922 and 93923?
CPT 93922 is defined as "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)." CPT 93923 is defined as "non-invasive physiologic studies of upper or ...
How do you bill for an ABI?
CPT CODES. The ABI study is reimbursable using CPT code 93922, 93923. The sudomotor study is reimbursable using CPT code 95923. The ABI and the Sudomotor study are two separate and billable events.
What ICD 10 code covers ABI?
Arterial 93925 & ABI 93922. Combination Ultrasound Exam.
Does 93923 need a modifier?
And when both the Upper and Lower extremities are evaluated we will use twice 93923 along with 59 or XS modifier depending on the client coding guideline. Because the code descriptions are stated as bilateral exams, use modifier 52 for reduced services if the study is only done on one side.
Does CPT code 93970 require a modifier?
Simultaneously, Modifier 26 (professional Component) with CPT 93970 is required to bill under physician NPI. The description of modifier 59 represents the different procedural services. This modifier is used with CPT 93970 when billed more than once on a single service date for the same patient.
Does Medicare cover venous duplex ultrasound?
The following is a list of procedures considered reasonable for Medicare reimbursement for the evaluation of new-onset DVT: Duplex scan (93970 or 93971). Doppler waveform analysis including responses to compression and other maneuvers (93965). Impedance plethysmography (93965).
What is the CPT code for lower extremity arterial Doppler?
Coding & Documentation Tips for Billing Vascular Duplex Ultrasound StudiesCPT CodeDuplex Ultrasound Study93925Lower extremity arteries or arterial bypass grafts; complete bilateral study93926Lower extremity arteries or arterial bypass grafts; unilateral or limited study13 more rows
What is the CPT code for vein mapping?
CPT code 93971 (Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study) for the following: Preoperative examination of potential harvest vein grafts to be used during bypass surgery.
What does CPT modifier 52 mean?
Modifier -52 identifies that the service or procedure has been partially reduced or eliminated at the physician's discretion. The basic service described by the procedure code has been performed, but not all aspects of the service have been performed.
What is the CPT code for lower extremity arterial Doppler?
Coding & Documentation Tips for Billing Vascular Duplex Ultrasound StudiesCPT CodeDuplex Ultrasound Study93925Lower extremity arteries or arterial bypass grafts; complete bilateral study93926Lower extremity arteries or arterial bypass grafts; unilateral or limited study13 more rows
What is the CPT code for venous Doppler ultrasound?
For evaluation of extremity veins for venous incompetence or deep vein thrombosis, use CPT codes 93970, duplex scan of extremity veins; complete bilateral study or 93971, unilateral or limited study.
What is the CPT code for vein mapping?
CPT code 93971 (Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study) for the following: Preoperative examination of potential harvest vein grafts to be used during bypass surgery.
General Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
Article Guidance
This article contains coding and other guidelines that complement the Local Coverage Determination (LCD) for Non-Invasive Vascular Studies.
ICD-10-CM Codes that Support Medical Necessity
The correct use of an ICD-10-CM code listed below does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in the attached determination.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
Document Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
CMS National Coverage Policy
Language quoted from Centers for Medicare and Medicaid Services (CMS), National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy.
Coverage Guidance
Abstract: Non-invasive vascular studies utilize ultrasonic Doppler and physiologic principles to assess irregularities in blood flow in arterial and venous systems. The display may be a two dimensional image with spectral analysis and color flow or a plethysmographic recording.
General Information
CPT codes, descriptions and other data only are copyright 2021 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
CMS National Coverage Policy
Italicized font represents CMS national language/wording copied directly from CMS Manuals or CMS transmittals.
Article Guidance
The billing and coding information in this article is dependent on the coverage indications, limitations and/or medical necessity described in the related LCD. Documentation Adequate documentation is essential for high-quality patient care and to demonstrate the reasonableness and medical necessity of the study (ies).
ICD-10-CM Codes that Support Medical Necessity
When CPT code 93926 is used to perform a limited study for a follow-up of bypass surgery, use the diagnosis code Z48.89 (encounter for other specified surgical aftercare). For codes in the table below that require a 7th character, letter A initial encounter, D subsequent encounter or S sequela may be used.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
General Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
CMS National Coverage Policy
Title XVIII of the Social Security Act, Section 1833 (e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period..
Article Guidance
This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD), L35451 Non-Invasive Peripheral Venous Studies.
ICD-10-CM Codes that Support Medical Necessity
It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim (s) submitted.
ICD-10-CM Codes that DO NOT Support Medical Necessity
All ICD-10 codes not listed under the "ICD-10 Codes that Support Medical Necessity" section of this article.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.